Rx Quality & Member Experience Analyst

Blue Shield of California; California; Hybrid; USD 103,000 - 154,000; Full time

Job summary

Blue Shield of California is seeking a Business Analyst, Consultant, Rx Quality Performance Management within the Clinical Pharmacy Programs team in the Pharmacy Strategy & Operations department.

You will support development, measurement, and continuous improvement of Pharmacy initiatives across Commercial and Medicare lines, using performance analytics, program management, and executive reporting to drive member-centered improvements.

Qualifications

• 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.

Responsibilities

• Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Lead the development of annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
• Develop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of management
• Define business requirements and provide analysis to increase operational efficiency
• Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinates with internal and external resources
• Expand subject matter expertise on performance monitoring of drug quality and member experience measures to support program improvement and enterprise goals
• Establish and sustain strong, collaborative relationships and operating model with data and technology partners internally and externally to ensure robust management of drug quality performance
• Work independently with limited oversight to achieve goals and objectives

Skills

Bachelor's degree

7+ years experience

Managed care experience

Advanced Excel/PowerPoint

Analytical skills

HEDIS/CAHPS/NPS data

Communication skills

Independent work

Education

Bachelor's degree

Job description

Blue Shield of California is seeking a Business Analyst, Consultant, Rx Quality Performance Management within the Clinical Pharmacy Programs team in the Pharmacy Strategy & Operations department.

You will support development, measurement, and continuous improvement of Pharmacy initiatives across Commercial and Medicare lines, using performance analytics, program management, and executive reporting to drive member-centered improvements.