Senior Quality Analyst (Hybrid)

CareFirst, Inc.; Baltimore, Northern (MD, KY); Hybrid; USD 72,000 - 144,000; Full time

Job summary

CareFirst BlueCross BlueShield in Baltimore seeks a Senior Quality Analyst to drive population health initiatives and quality improvement. You will be responsible for defining, measuring, and evaluating performance, and delivering actionable reports to improve care and member experience.

The role requires 5+ years in healthcare analytics, knowledge of NCQA accreditation, and strong data analysis skills using SQL, Python, and R.

Qualifications

• Bachelor's Degree or higher in a population health, public health, healthcare administration, business, or related field; or 4 extra years of relevant work experience in lieu of degree.
• Experience in a business environment with progression in responsibilities; 5 years preferred.
• Certifications in quality or process improvement preferred.

Responsibilities

• Act as subject matter expert in population health, measurement science, accreditation, and quality improvement.
• Define, measure, and document performance of the health plan in quality and member experience.
• Analyze health plan performance using qualitative and quantitative methods; produce actionable reports.
• Prioritize and operationalize opportunities into innovative programs; collaborate across the organization.
• Mentor team members and guide complex work; support special projects.

Skills

SQL

Python

R

Excel

Education

Bachelor's Degree in a related field

Tools

SQL

Python

R

Excel

Job description

Resp & Qualifications

PURPOSE:
The Senior Quality Analyst is responsible for the most complex work of the team in defining, measuring, analyzing, and evaluating population health, while prioritizing, developing, and operationalizing innovative initiatives to improve the quality of care and experience, resulting in industry-leading outcomes at a population level. Independently responsible and accountable for ensuring that their work aligns with and helps to achieve the organization's vision as it relates to population health, quality, and member experience. Serves as peer mentor within the team.

We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.
ESSENTIAL FUNCTIONS:

• Act as the organization's subject matter expert in population health, measurement science, accreditation, and quality improvement.
• Utilizes the framework of NCQA Accreditation to accomplish and document the work products.
• Define, measure, and document the performance of the health plan in facilitating quality healthcare, positive outcomes, and excellent experience for members.
• Analyze and evaluate health plan performance using qualitative and quantitative methodologies, producing actionable and insightful reports and visualizations addressing population health quality opportunities.
• Prioritize, develop, and operationalize these opportunities in collaboration with other areas of the organization into innovative programs and initiatives
• Mentor team members and provides guidance on most complex work efforts. Assist with special projects and/or department initiatives that require thought leadership and subject matter expertise in a consultative manner.

SUPERVISORY RESPONSIBILITY:

Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

QUALIFICATIONS:

Education Level: Bachelor's Degree, Associates in population health, public health, healthcare administration, business administration, health policy, economics, statistics, mathematics, data science, or a related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications Preferred:

• RN-BC - Certified General Nursing Practice
• Licensed Medical Professional

Experience: 5 years professional experience in a business environment (public health, health insurance, management consulting fields preferred); evidence of progressing levels of responsibility.

Preferred Qualifications:

• Certification in Quality or Process Improvement Methods.
• Direct experience with accreditation, HEDIS, CAHPS and other quality related activities a healthcare related environment and/or payor organization.
• Data analytics experience working with large data sets to answer clinical, operational, or business questions; prior experience with healthcare data expected.

Knowledge, Skills and Abilities (KSAs)

• Expertise in qualitative and quantitative data analyses and presentations.
• End-to-end experience designing, developing, and implementing innovative strategies to improve
  population health.
• Experience self-managing multiple projects and provide regular status reports.
• Ability to conduct advanced analytics using SQL, Python, R, or similar.
• Fluent in the use of Microsoft tools including Excel, Word, Power Point and Outlook.
• Expertise with healthcare claims, survey, clinical, and health data.
• Ability to mentor and guide other team members and lead initiatives in a matrix environment.
• Remote electronic medical record experience.
• Ambulatory practice experience required.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $72,432 - $143,858

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Data and Analytics, Stars Risk

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of theCompany to provide equal employment opportunities to allqualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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