Clinical Quality Analytics, Consultant

Your Role

The Clinical Quality Analytics and Informatics team delivers best-in-class clinical quality analytics and informatics to enable high quality and affordable member-centered care. Our data, intelligence, and actionable insights help drive quality strategy, performance improvement, and regulatory reporting. The Clinical Quality Analyst - Consultant will report to the Clinical Quality Analytics Senior Manager with day-to-day oversight provided by the CalPERS analytic lead. In this role you will provide data, analytic and reporting support, in partnership with the Clinical Quality Department, for the BSC CalPERS HMO/PPO lines of business. This includes monthly executive reporting, tableau dashboards, member engagement and adhoc analytics.

Your Knowledge and Experience

• Requires a bachelor's degree in health science, quantitative social science, public health, health services research or business or equivalent experience
• Prefer an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business
• Requires at least 5 years of SAS/SQL programming experience
• Requires at least 7 years of prior operational and / or data analysis experience, experience in database structures, and standard query and reporting tools
• Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
• Requires at least 3 years of experience working with NCQA HEDIS quality measures
• Requires at least 3 years of experience with NCQA Health Plan Rating, CMS Medicare Advantage Star Rating or Medi-Cal Managed Care Accountability Sets (MCAS)
• Requires at least 5 years of programming using inpatient claims, outpatient encounters, membership, pharmacy or laboratory data.
• Requires at least 5 years of experience with ICD (International Classification of Diseases) codes, CPT (Current Procedural Terminology) codes, Diagnostic Related
• Proficient in MS Office - Word, Excel and Powerpoint
• Experience with visual management tools (eg. Tableau, Power BI) or task management tools (eg. JIRA, Work Front, Sharepoint) or cloud data (eg. Azure, AWS, Snowflake)
• Experience working with RDBMS: Oracle, Netezza, DB2 etc.
• Group (APR-DRG/MS-DRG) codes or Healthcare Common Procedure Coding System (HCPCS) codes
• Experience utilizing a certified HEDIS software

Pay Range:

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.