Business Analyst, Consultant - Quality Performance

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 110,000 - 165,000; Full time

Job summary

The Clinical Pharmacy Programs team within the Pharmacy Strategy & Operations department at Blue Shield of CA leads strategies to improve clinical quality, member experience, and affordability of prescription medications for members.

The Business Analyst, Consultant, Rx Quality Performance Management reports to the Senior Manager, Rx Member Experience & Quality Performance and supports development, measurement, and continuous improvement of Pharmacy initiatives across Commercial and Medicare

Qualifications

• Bachelor's degree or equivalent experience.
• 7+ years of relevant experience.
• 3+ years in managed care preferred.
• Strong analytics using pharmacy data and related standards.
• Excellent written and verbal communication skills.
• Independent thinker in a fast-paced environment.

Responsibilities

• Support development, measurement, and continuous improvement of Pharmacy initiatives across Commercial and Medicare lines of business.
• Perform analytics, program management, and provider/member experience insights to identify opportunities.
• Prepare executive reporting and dashboards to track outcomes and drive member-centered improvements.
• Collaborate with cross-functional teams to implement improvements.

Skills

Analytical skills

Problem solving

Microsoft Office

Communication skills

Independent worker

Education

Bachelor's degree

Tools

Microsoft Excel

PowerPoint

SharePoint

Data visualization

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.