Quality Programs Measurement Analytics Consultant (Finance)

Job Description:

This position consults with internal and external stakeholders in order to extract, analyze and develop reports in ways that can be easily understood and complete with summaries and recommendations on findings to drive continuous improvement in measure results across all lines of business. Incumbents have the responsibility to understand HEDIS/CAHPS, Quality Assurance Reporting Requirements (QARR), Quality Rating System (QRS) reporting requirements along with influencing the Health Plan's quality ratings performance. The consultant monitors trends, outcomes and business processes using data mining techniques, statistical techniques, (i.e., control charting) and additional business intelligence technologies. This position partners with other analytical areas, project teams, external regulators and other Health Plans.

Essential Primary Responsibilities/Accountabilities

Level I:

• Develops on-going knowledge of Health Plan's data sources and structures to independently take in business requirements, design and execute on requests
• Independently seeks to understand the business/programs and partners at the Health Plan to better understand the business requirements (the 'why') of the request and applies both knowledge of the business and analytic skills to proactively fulfill request. Ultimately collaborates with business partners before and as the data is pulled so the most meaningful information is provided initially. Also, follows up with business partners to ensure timely completion of request and is available to communicate a clear and concise understanding of analysis.
• Participates on departmental and Health Plan project teams with other staff in the Health Plan providing detailed reports, outcome analysis and return on investment, if applicable.
• Prepares, develops, analyzes quality measure data. Ensures that all data are accurate and that the results are provided in a timely manner.
• Collaborates with other Quality Measurement Analytic Consulting team members, leveraging skill sets across the team and aiding in growth and development, as needed. Collaborates with the clinical team to advance partnerships and measure knowledge.
• Understands measure performance for assigned measures, future changes and design along with clinical insight from clinical team.
• Understanding of NCQA and Medicare STARS, Medicaid Quality Incentive, Quality Rating system requirements and results.
• Proactively problem solves, investigates and brings forward concerns to peers, management and other Health Plan analytical teams with relation to data pulls and analyses results.
• Uses appropriate analytic tools for particular data analysis (considering efficiency and automation of standard/repetitive reports) and documents logic to ensure that all reports are starting from the same source of truth to supply data that is in line with our Enterprise definitions.
• Proficient in HEDIS software system and reporting interface. Attends any pertinent mandatory training.
• Builds relationships across the organization and appreciation/understanding of other analytic units, business practices, product design and operational areas.
• Organizes and prioritizes tasks, proposes work assignments so as to successfully complete projects in a timely manner and completes desk level procedures as appropriate.
• Manages multiple projects, workstreams with competing deadlines to successful completion.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II (in addition to Level I essential responsibilities/accountabilities):

• Utilizes SAS, Cognos and Microsoft tools to develop reports as appropriate and in depth knowledge of HEDIS software, Health Plan EDW (or related claims data sets) or Medical/Pharmacy Management Systems while becoming familiar with the other data sets or systems.
• Trains and mentors peers.
• Participates/represents Quality Measurement Analytics and Consulting as a subject matter expert in cross-sectional team meetings and with internal departments as needed.
• Determines areas of focus for measure improvement
• Facilitates the administration of surveys (e.g. CAHPS)
• Supports corporate NCQA requirements and has a working knowledge of the intersection with HEDIS/CAHPS and NCQA.
• Recommends and/or develops comprehensive data strategies for optimal SAS/BI Tool utilization and connectivity with other analytic tools.
• Handles more complex requests and provides more in depth analytic results and recommendations to team, customers and regulatory agencies, if applicable
• Contributes to the development or develops quantitative and qualitative models that improve quality rating results for the organization.
• Integrates visual analytic techniques into reporting to enhance end users understanding of information.
• Collects/analyzes and presents data as information (tell a story) and makes concise recommendations to customers involving simple and complex problems.
• Devises strategy for producing deliverables, selecting and utilizing the most appropriate analytic tool, as well as, begin to build process efficiencies.

Level III (in addition to Level II essential responsibilities/accountabilities):

• Utilizes all relevant and available tools that optimize reporting efficiency for consumption by team, project teams, internal and/or external stakeholders with user friendly tools to run repetitive reports self-service.
• Reviews and evaluates emerging trends in HEDIS measurement, healthcare and considers/recommends appropriate modifications.
• Develop and operationalize datamarts, predictive models and Power BI dashboards.
• Recommends innovative program designs to support quality measurement, operational processes and customer needs.
• Uses knowledge of HEDIS, datasets/warehouse to produce reports that tie information that illustrates the effectiveness of health plan performance with provider and employer group partnerships.
• Acts in a consultative capacity to help business units define analytics that drive business improvements.
• Serves as member of advanced analytic workgroup to prepare datasets for mining and predictive modeling activities.
• Provides expertise in relational database concepts to Informatics areas, as well as, customers.
• Seeks out opportunities to train and mentor fellow analysts within the framework of the department.
• Demonstrates keen judgment on involved and complex assignments; devises methods and procedures to meet unusual conditions and makes original contributions to the solution of very difficult problems. Problem solving is complex and involves critical issues.
• Explores data and performs advanced programming and statistical analysis/support for ad hoc requests.
• Provides statistical guidance and alignment in developing Health Plan strategic initiatives.
• Provides oversight and guidance of reporting and data collection methodology and processes.

Level IV (in addition to Level III essential responsibilities/accountabilities):

• Recommends to leadership advanced analytic models and/or research that financially (potentially sizably) impact pricing, cost containment, quality, marketing and risk management functions.
• Develops large, complex advanced analytic models and performs data mining functions to identify trends in the data and/or opportunities for improved outcomes.
• Improves visual analytics throughout the organization.
• Interacts with Health Plan leadership to interpret model output and make business inferences that address strategic needs.
• May work on multiple predictive models simultaneously.
• Assesses need and opportunity for upgrades to existing or new analytic products (i.e. SAS or Cognos products).
• Prepares and submits studies for journal publication or presentation at national meetings.

Minimum Qualifications

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

Level I:

• Bachelor's degree in Mathematics, Statistics, Informatics, Economics, Public Health or related field with a minimum of two years' experience in data or information analysis and reporting. In lieu of a degree, six years of related experience is required.
• Knowledge and applicable use of all tools available to develop analyses, extract information and using the most appropriate tool for the given report is required (i.e. SAS, Cognos, Excel, Access, etc.). Ability to approach data analysis with different data mining and statistical techniques
• Working knowledge of Microsoft Office Suite.
• Knowledge of basic statistical concepts and strong analytical and problem-solving skills with attention to detail.
• Demonstrates intermediate understanding of healthcare products and operational business knowledge.
• Demonstrates analytic abilities combined with capabilities for completing projects with minimum degree of supervision.
• Knowledge of the health care system and experience working with physician or hospital claims data preferred.
• Excellent oral and written communication skills with aptitude for communicating to a variety of audiences.
• High degree of initiative, proactive attitude and commitment to teamwork.
• Demonstrates ability to effectively interact with internal and external customers. Adaptable to constant industry change and rapidly changing priorities.
• Willingness to solicit and respond to customer feedback.
• Proficient in using analytic processes and tools such as Excel, Access, COGNOS and SAS. Seeks to learn tools new to the industry and how to incorporate into existing processes (e.g., Power BI, etc.)

Level II (in addition to Level I minimum qualifications):

• Master's degree preferred.
• A minimum of three years' analytic experience in Healthcare industry.
• Knowledge of advanced statistical concepts and possesses strong analytical and problem-solving skills.
• Demonstrated ability to effectively interact with internal and external customers with strength translating user information needs into requirements and delivering high quality results.
• Must have the ability to work with large datasets (2TB or greater) and integrate large data across multiple sources (structured and unstructured).
• Strong PC/programming skills including Microsoft Excel, Access, Word, PowerPoint, VBA, SQL, Power Play and Impromptu and moderate proficiency in SAS required.
• Strong analytical, diagnostic, and problem-solving abilities with attention to detail.
• Ability to quickly develop expertise in new application domains and analytic tools.
• Consistently demonstrated high quality and accuracy of work.
• Self-motivated, takes initiative, and demonstrates an ability to perform under pressure with little supervision.

Level III (in addition to Level II minimum qualifications):

• Masters Degree with at least two years of statistical analysis preferred.
• A minimum of five years' experience using statistical concepts and tools.
• Demonstrated expertise in relational database concepts.
• Demonstrates advanced statistical capabilities, data mining, forecasting and predictive modeling skills, and/or actuarial techniques.
• Demonstrated skills in quality principles especially root cause analysis and problem solving.
• Demonstrated business and technical problem-solving skills.
• Extensive experience in analytic tools required (i.e. SAS, CognosSPSS or others).

Level IV (in addition to Level III minimum qualifications):

• MS or MA in Statistics, Economics or related discipline preferred.
• A minimum of three years' health care specific predictive modeling experience
• Ability to create, develop/validate models independently.
• SAS Certification or similar Analytic Software certification preferred.
• Project Management/Process Improvement knowledge preferred.
• Continued professional growth in analytic software tools (i.e. SAS competency as evidenced by successful passing of Advanced Certification Exam and/or Certified Predictive Modeler Exam)
• Project Management (PMP, Six Sigma) experience desired.
• Advanced analytic software programming proficiency required (i.e. experience with SAS EBI suite - Information Maps, Stored Processes, Web Report Studio, Information Delivery Portal).

Physical Requirements:

• Works from a stationary desk a majority of time.

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One Mission. One Vision. One I.D.E.A. One you.

Together we can create a better I.D.E.A. for our communities.

At the Lifetime Healthcare Companies, we're on a mission to make our communities healthier, and we can't do it without you. We know inclusion of all people helps fuel our mission and that's why we approach our work from an I.D.E.A. mindset (Inclusion, Diversity, Equity, and Access). By activating all of our employees' experiences, skills, and perspectives, we take action toward greater health equity.

We aspire for our employees' interests and values to reflect the communities we live in and serve, and strongly encourage all qualified individuals to apply.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing an inclusive workforce, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

E1: $60,410 - $84,000

E3: $60,410 - $106,929

E5: $71,880 - $129,384

E6: $79,068 - $142,322

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

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