Hybrid Senior Healthcare Process & Analytics Advisor

Clever Care Health Plan; Huntington Beach (CA); Hybrid; USD 110,000 - 140,000; Full time

Job summary

Clever Care Health Plan is seeking a Senior Business Process Advisor, Quality & Risk Adjustment, to serve as the primary liaison across Risk Adjustment, Quality/Stars, Clinical Operations, and IT. You will translate CMS requirements into scalable workflows, reporting, and tech enhancements aimed at improving Medicare Advantage performance.

You will lead requirements, testing, and validation across Stars, HEDIS, CAHPS, RAF optimization, and population health initiatives, driving data-driven

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Public Health, Information Systems, Data Analytics, or related field.
• Minimum five (5) years of experience in healthcare business analysis, healthcare operations, managed care, Medicare Advantage, or health plan analytics.
• Minimum three (3) years supporting Medicare Stars, HEDIS, CAHPS, Risk Adjustment, Population Health, or related programs.

Responsibilities

• Lead requirements gathering and translate business objectives into functional and technical requirements.
• Develop BRDs, process flows, use cases, data dictionaries, and testing plans.
• Support Stars, HEDIS, CAHPS programs with analytics and reporting solutions.
• Validate risk adjustment reporting, RAF data, and provider scorecards.
• Lead UAT and testing activities for new applications, reports, dashboards, and workflows.
• Coordinate cross-functional collaboration across stakeholders and IT.

Skills

Analytical thinking

Cross-functional collaboration

Leadership (UAT)

Problem solving

Education

Bachelor's degree in Healthcare Administration / Business / Public Health / IS / Data Analytics

Tools

Power BI

SQL

Excel

Salesforce

Tableau

Job description

Clever Care Health Plan is seeking a Senior Business Process Advisor, Quality & Risk Adjustment, to serve as the primary liaison across Risk Adjustment, Quality/Stars, Clinical Operations, and IT. You will translate CMS requirements into scalable workflows, reporting, and tech enhancements aimed at improving Medicare Advantage performance.

You will lead requirements, testing, and validation across Stars, HEDIS, CAHPS, RAF optimization, and population health initiatives, driving data-driven