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Resp & Qualifications

PURPOSE:

The Medicaid Quality Analyst is responsible for defining, measuring, analyzing, and evaluating population health, while prioritizing, developing, and operationalizing innovative initiatives to improve HEDIS measure performance, the quality of care and experience, resulting in industry-leading outcomes at a population level.

ESSENTIAL FUNCTIONS:

• Act as the organizations 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.

QUALIFICATIONS:

Education Level: Bachelor's Degree 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:

• RN-BC - Certified General Nursing Practice Preferred.

Experience: 3 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.

• Candidate must have Medicaid experience.

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.

• 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.

• Knowledge of healthcare claims, survey, clinical, and health data.

• 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: $63,576 - $126,269

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 responsibilites 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

Quality and Accreditation

Equal Employment Opportunity

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

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

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

#LI-NH2

REQNUMBER: 19826