Blue Shield of CA
Clinical Quality Analytics, Consultant
Blue Shield of CA, Sacramento, California, United States, 95828
Your Role
The Clinical Quality Analytics 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 Analytic Senior Manager under the day-to-day supervision of the Clinical Quality Analytics - Principal, Medicare Lead. In this role you will provide data, analytic and reporting support for the Clinical Quality Department to improve Blue Shield of California and Promise Health Plan - Medicare quality performance for regulatory and accreditation requirements including National Committee for Quality Assurance, Centers for Medicare and Medicaid and Department Health Care Service.
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
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.
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 Group (APR-DRG/MS-DRG) codes or Healthcare Common Procedure Coding System (HCPCS) codes
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
Experience utilizing certified HEDIS software
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)
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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
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.
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 Group (APR-DRG/MS-DRG) codes or Healthcare Common Procedure Coding System (HCPCS) codes
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
Experience utilizing certified HEDIS software
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)
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