• Population Health & Quality Data Analyst II

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5157
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Population Health & Quality Analyst II leads several projects simultaneously, analyzes Member Gap in Care data by region and by line of business (Medicaid, MLTSS, Medicare and Commercial), Electronic Medical Records, Health Information Exchange, financial reporting, and other data sources to identify trends in utilization, outcomes, and costs, and opportunities for quality improvement activities. Responsibilities include analysis, research, reporting, and interpreting business, clinical and financial information to assist management in the formation, implementation, and evaluation of population health and quality initiatives. The incumbent will support Population Health, Quality, NCQA, HEDIS, CAHPS, DMAS, CMS, with the HEDIS reporting application, quality documentation in the clinical platform, annual evaluation analyses, quality studies, departmental metrics, developing an extensive expertise in the collection and analysis of population health and quality data, and collaborating with the Pay for Performance Team and other departments, as needed. In this analytical position, the incumbent will support continuous improvement in all technical and reporting aspects of Population Health, Quality, NCQA, HEDIS, CAHPS, DMAS, CMS, and all related activities. This position will assist with the planning, and developing enhancements to the application by working with vendors as well as applying upgrades, service packs and hot fixes. The position will assist management with design issues, running reports for the Population Health Outcomes Department and any other technical problem solving. This position is responsible for simple statistical analysis for large datasets and programmatically restructure database. This position will also assist with operational and production dashboards/reports for all LOBs. This position interprets analyses and writes quality reports related to Population Health, Quality, NCQA, HEDIS, CAHPS, DMAS, CMS, and other required entities associated with or required by the accrediting (i.e., NCQA) and regulatory entities (i.e., DMAS and CMS). 

     

    Responsibilities

    • Provide system administration support to the quality and population health application used for NCQA, State and CMS reporting.
    • Review and analyze population and member data related to clinical care and outcomes,
    • Evaluate performance, reveal trends, and identify opportunities for improvement
    • Provide recommendations of specific actions or work based on analysis and research
    • Prepare various reports to present findings and to highlight successes and opportunities for improvement or intervention
    • Format and display data in creative ways to effectively communicate findings to different audiences, including health care providers and organizational leadership
    • Evaluate population health and quality programs and initiatives
    • Make recommendations to Management as it pertains to quality and population health data trends
    • Monitoring the completeness and accuracy of data collected and compiled in the databases and assist the Manager with regular progress reports for staff.
    • Work with the Manager to generate the reports, to include the HEDIS Roadmap and other analyses. Participates in implementation of performance improvement activities, including HEDIS projects, as assigned; assists with the design and development of healthcare data retrieval tools, flow charts and review processes for HEDIS and other quality improvement monitoring activities.
    • Generate population health and quality related reports daily, weekly, or as needed
    • Understands the different data sources and their inter-relationships; develops the capability to use multiple sources of information to locate member charts and information for various quality improvement initiatives
    • Assist Population Health and Quality Teams with training staff on the population health and quality (ex. HEDIS) application and tools
    • Conduct drill down reports on gap in care reports
    • Prepare analyses for the annual evaluations, for all LOBs, as requested
    • Ability to navigate and interpret the claims, clinical and member operations systems
    • Ability to conduct statistical analysis to make data-driven recommendations and decisions
    • Assist with operational and production dashboards/reports for all LOBs
    • Assist many operational procedures including the HEDIS program, to include Clinical HEDIS measures, CAHPS, HOS, the Board Certification Measure and Call Measures
    • Assist to develop the documentation related to workflow and process to include an updated process map (at all times)
    • Build and maintain Provider Report Cards
    • Responsible for assuring the accuracy and validity of both source data and results and interpreting results into recommendations
    • Collaborate with population health and quality managers to develop annual HEDIS project plans and monitor the HEDIS project plans for all LOBs
    • Develop and maintain HEDIS based reports to support quality initiatives
    • Work collaboratively to ensure electronic data feeds into the HEDIS Inovalon System
    • Assist the quality related reports and analyses for internal and external needs
    • Complete simple analyses for HEDIS measures, STAR Rating measures, NCQA measures and other indictors as determined, analyzes data, generates reports based on findings and submits recommendations based upon results
    • Develop trend reports for all population health and quality data to include quality of care, site visits, CPG audits, HEDIS rates, STAR rates, and other deliverables as assigned
    • Develop report for the state and other regulatory or accrediting entities
    • Perform ad-hoc analyses and support special projects as requested
    • Other duties as assigned

    Qualifications

    MINIMAL FORMAL EDUCATION REQUIRED

    • Bachelor’s degree in Health Care Administration, Computer Science, Information Systems, Business Administration or related field and/or equivalent clinical experience
    • 1-3 years of direct experience in a managed care organization 

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Knowledge of HEDIS, STAR measures, and implications for NCQA accreditation
    • Ability to work independently and within a team environment
    • Collaborates effectively with clinical subject matter experts
    • Collaborates effectively with information technology and informatics/analytics department
    • Effectively collaborates with multi-disciplinary departments throughout the organization, including communication, facilitation, problem solving and organization/prioritization skills
    • Must have the ability to manage multiple projects simultaneously
    • Exceptionally strong critical thinking and problem solving abilities with a track record of identifying insights from quantitative and qualitative data
    • Ability to create compelling visual presentations that tell a story

    WORK EXPERIENCE/BACKGROUND REQUIRED:

    • Experience with MS Office, MS Project, Project Server and MS OneNote preferred
    • Advanced MS Excel knowledge
    • Experience with SharePoint preferred
    • Openly and actively communicates information and takes initiative to communicate with co-workers
    • Strong interpersonal skills, with the ability to interact effectively with all levels of staff
    • Demonstrated ability to identify and document issues and risks and propose solutions
    • Strong communication skills, both written and verbal
    • Ability to work independently, with minimal supervision and as part of a team
    • Strong organizational and prioritization skills
    • 6 months business analytical experience possibly including Claims or Healthcare related experience preferred
    • 1+ year experience writing TSQL or SQL queries preferred, but not required

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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