Data Analyst - Health, Principal

Your Role 

The Clinical Quality team is accountable for the quality ratings of the organization, for improving preventive care outcomes for Blue Shield of California’s Commercial members and for managing financial risks associated with Quality performance. The Health Data Analyst for Clinical Quality (Principal) will report to the Director of Clinical Quality. In this role you will drive ratings achievement strategy, build outcomes forecasts for quality interventions and regional support models, and develop the measurement strategy for five Commercial lines of Business. This includes accountability for data models, analysis and recommendations based on the National Committee for Quality Assurance (NCQA) STAR ratings, HEDIS and CAHPS measures. This role also develops predictive modeling techniques for preventive care patterns.

Your Work

In this role, you will:

• Develop and conduct evaluations and studies within limited time frames and produce analyses that are easy for non-technical persons to understand
• Apply advanced statistical methods, advanced analytics and modeling techniques, visualization techniques, and advanced programming to innovate our products and services
• Identify how our customers are accessing our provider networks to make strategic decisions and generate/implement ideas to improve our services and enable decision support
• Work with cross-functional partners to engineer new services/analytics that improve member satisfaction and access to preventive care; estimate the resources needed and provide planning and support for innovation
• Conduct proof of concept using techniques that can quickly contemplate the viability of a change in service, network or quality intervention
• Manipulate large, structured and unstructured data sets to develop quality ratings and operational insights for Senior/Executive Management review
• Create predictive models with new/emerging data sets relying on input from a variety of public health and research inputs and build new analytic bridges between claims, encounter and supplemental data sources
• Work cross-functionally with utilization, pharmacy, transformation, quality, product and other cross-functional teams to support root cause analysis, quantitative data analysis and interpretation, annual strategic planning, and return-on-investment (ROI) calculations
• Use evaluations and analysis to inform quality strategy, quality operations planning, execution around process improvements for the organization, its provider networks, member and provider incentive designs, and member engagement services
• Ensure compliance with regulatory, purchaser and accreditation requirements to provide the most equitable preventive care and services offered in the market 

Your Knowledge and Experience

• Requires an MPH, MBA, MS, MA in science, social science, public health, health svcs research or business, or BA/BS with demonstrated equivalent work experience
• Requires at least 10 years of prior relevant experience
• Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
• Requires demonstrated experience in quality analytics that drive successful member and provider engagements, return on investment, community impact or healthcare savings 
• Requires at least 5 years of demonstrated experience managing outcomes that contribute to results in complex Quality Ratings Systems, including HEDIS and CAHPS improvement initiatives executed within the state of California and/or within a healthplan regulated by the Department of Managed Health Care, resulting in outcomes improvements for a diverse member population 
• Requires at least 3 years of demonstrated experience with HEDIS and/or CAHPS measurement, forecasting, and improvement, or similar Quality Improvement ratings systems, as well as successful participation in annual financial modeling, resource negotiation and operational planning in environments of rapid execution; strategic planning 
• Demonstrated experience creating population forecast models as well as experience with leveraging disaster planning or acute care planning models for the improvement of primary or outpatient care workflows preferred; Six Sigma and LEAN training preferred
• Prefers demonstrated experience supporting and influencing large, statewide change management efforts with the ability to communicate complex ideas simply and succinctly both verbally and in writing, including ability to speak comfortably and extemporaneously to diverse audiences, capable of self-management and inspiring others to take action through influence and relationship building

Pay Range 

The pay range for this role is: $ 136400.00 to $ 204600.00 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.

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