Business Analyst, Consultant - Quality Performance

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 110,000 - 160,000; Full time

Job summary

Blue Shield of CA is seeking a Business Analyst, Consultant, Rx Quality Performance Management to support development, measurement, and improvement of Pharmacy initiatives. You will combine performance analytics, program management, member experience insights, and executive reporting to identify opportunities and drive member-centered improvements.

The role emphasizes cross-functional collaboration within the Clinical Pharmacy Programs team and reports to the Senior Manager, Rx Member Experience

Qualifications

• Bachelor's degree or equivalent experience.
• At least 7 years of prior relevant experience.
• Minimum of 3 years in managed care preferred.
• Strong analytics and problem-solving with pharmacy data elements.
• Experience with HEDIS, CAHPS, NPS and Medicare Stars data preferred.
• Advanced proficiency in MS Office: Word, Excel, PowerPoint, OneNote, SharePoint.
• Excellent written, verbal, and interpersonal communication.
• Ability to work independently in a fast-paced environment.

Responsibilities

• Support development, measurement, and improvement of Pharmacy initiatives across Commercial and Medicare.
• Utilize performance analytics, program management, and executive reporting to drive improvements.
• Provide member-experience insights to inform decisions and actions.
• Collaborate with the Rx Strategy & Operations teams to enable data-driven outcomes.

Skills

Analytical skills

Problem-solving

Microsoft Office

Communication

Independent worker

Pharmacy data familiarity

Education

Bachelor's degree or equivalent experience

Tools

SharePoint

Job description

Your Role

The Clinical Pharmacy Programs team within the Pharmacy Strategy & Operations department is a team of pharmacy professionals responsible for defining and executing strategies to address clinical quality, member experience, and affordability of prescription medications used by Blue Shield members. The Business Analyst, Consultant, Rx Quality Performance Management will report to the Senior Manager, Rx Member Experience & Quality Performance. In this role you will support the development, measurement, and continuous improvement of Pharmacy initiatives across the Commercial and Medicare lines of business. This role combines performance analytics, program management, member experience insights, and executive reporting to identify opportunities, measure outcomes, and drive member-centered improvements.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building, and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• A minimum of 3 years' experience in managed care is preferred
• Requires strong analytic and problem-solving skills with intermediate to advanced knowledge of pharmacy data elements and related technical standards/concepts (e.g. claims, e-prescriptions, e-prior authorization, real time pharmacy benefits, etc.) Experience with HEDIS, CAHPS, NPS and Medicare Stars data preferred.
• Requires advanced proficiency in Microsoft applications including Word, Excel, Power Point, OneNote, SharePoint
• Requires excellent written, verbal, and interpersonal communication skills
• Requires experience working independently in a fast-paced environment

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.