Quality Analytics Project Lead

Job Details:

Job Location:

Smithfield, RI - Smithfield, RI 02917, Position Type:
Full Time, Education Level: Bachelors Degree, Travel Percentage:
Occasional, Job Shift: Daytime, Job Category:
Professional / Experienced, Responsible for reviewing and assisting in the coordination, planning, design and implementation of large scale projects, using cutting edge quantitative methodology to better understand the quality of care being delivered to our members. This position works with management providing analytical advice and support to define scope and resources of projects. Serves also as a liaison to external partners/organizations on important projects that require the performance of data analysis and reporting.

This role requires strong management and communication skills and good understanding of health care data. Acts as subject matter expert with SAS and/or SQL and be able to train internal staff on SAS and SQL techniques and best practices.

• Continually analyzes clinical quality of care performance data to identify opportunities to improve services and outcomes for members and to monitor progress of improvement efforts
• Provides technical support for collection of data through medical chart review and submission of collected data through synchronized data uploads
• Perform all quality reporting for all Accountable Entities (AE) related work such as clinical quality of care analysis, HEDIS analysis and other related information
• Provide analytical and technical support for the production of clinical quality care rates including:
  • Generate the HEDIS test and production files
  • Create test environments to ensure accurate HEDIS rates
  • Create and maintain libraries and quality standard documentation
  • Review and continuous improvement of report content and format
• Analyzes and/or coordinates the production of clinical quality and other data to:
  • Identify opportunities for improvement in Neighborhoods clinical performance
  • Create reports supporting the implementation of intervention activities
  • Support continuous quality improvement of intervention activities
  • Attend all Quality Improvement committees and work groups
• Supports the use of evidence-based findings to identify and select interventions designed to improve quality of care performance
• Provides technical support and facilitation to multi-disciplinary teams formed to improve performance on specific quality of care measures or groups of measures
• Aligns and coordinates with clinical quality improvement efforts in disease management, pharmacy, behavioral health and other areas within the company to achieve HEDIS improvement targets
• Provide guidance and mentoring to other members of the team and the department
• Trains Quality HEDIS Data Analysts on SAS techniques and best practices
• Assist in the coordination, development and production of large scale and high-profile projects
• Shared responsibility with the manager for representing the department and the organization on projects with external partners
• Responsible for critically reviewing data analysis requests, assigning resources and assisting business owners in the interpretation of data and analysis results
• Deliver regular feedback to the manager and director of the department on performance and project status
• Coordinates information from multiple data sources, assures timely delivery of reports and analysis requests, performs quality assurance data review, helps senior management interpret data and contributes to continuous process and product improvement
• Experience with data integrity strategies and process improvement
• Performs other duties as assigned

• Bachelor degree in a quantitative field, health related area or Information Technology
• Four (4)+ years of Managed Care/Health Care experience
• Five (5)+ years of SAS and/or SQL development (SAS Preferred)
• Three (3)+ years working with Medicaid and Medicare products
• One (1)+ year leading large scale analysis projects
• Experience with methods to assess accuracy of HEDIS data extraction and HEDIS data manipulation processes, test HEDIS programs to ensure that they perform as intended
• Experience with HEDIS specifications and program measures for NCQA
• Experience with HEDIS Performance reporting, Data Warehousing and NCQA accreditation
• Experience with SAS and/or SQL to extract and manipulate data to achieve desired results using select statements, sub-queries, functions, links of multiple tables, etc.
• Experience extracting and manipulating Claims, Provider, Member,…