Commonwealth Care Alliance
Overview
The HEDIS Network Analyst will support CCA’s ability to meet and surpass critical Quality benchmarks and optimize member outcomes as measured through critical measures. The role supports efforts of the Network and Provider Contracting department and will have regular interaction with internal Clinical, Quality, and BI departments, while frequently interfacing with Providers within CCA’s Network. The objective of this role is to reduce and/or prevent loss of revenue due to below-benchmark performance on critical Quality measures. Priority measures may shift year-to-year as dictated by organizational performance trends and the Network’s ability to impact these trends. The role’s three key areas of focus are:
Identify underperforming Providers
Work cross-functionally to determine reasonable expectations and solutions
Facilitate and implement Provider specific and/or Network improvement initiatives
Current year priority measures include Initiation and Engagement of Alcohol or Other Dependence Treatment (IET) and Follow-Up after Hospitalization for Mental Illness (FUH). The ideal candidate will have strong organizing skills, analytic capabilities, and the ability and comfort with working across internal and external stakeholders to coordinate initiatives and projects affiliated with Quality performance improvement.
Essential Duties & Responsibilities
Conduct weekly tracking of Quality/HEDIS metrics, specifically focused on IET and FUH data.
Work with BI, Quality, and BH teams to evaluate and build data sources delivering accurate performance data and reliable actionable data.
Track performance trends on a weekly basis, evaluating member-specific and provider-level details.
Identify reasons for low and high performance; determine which providers are performing well or struggling; analyze which diagnosis settings lead to missed opportunities for timely Initiation visits.
Identify which Network providers are excelling and which are underperforming.
Design IET and FUH data formats that are user-friendly and can be shared with relevant Network Providers (including those with delegated arrangements).
Review YTD claims files on a monthly/quarterly basis to identify errors and address accordingly with appropriate SMEs.
Meet with select Providers and HHs to discuss IET and FUH performance and workshop improvement interventions with short-term and long-term goals.
Understand barriers and challenges providers are experiencing; work with high performers to build tips and best practices for lower performing entities and internal teams.
Determine regular cadence to check in with lower performing HHs and Providers to monitor progress.
Partner with CCA Clinical teams and programs to roll out initiatives aimed at leveraging Providers to improve Quality measures.
Train and educate Provider Network on the measures by organizing trainings, building reference documents, and creating webinars; ensure materials are appropriate for different Provider audiences.
Working Conditions
This is a remote role with standard operating hours of 8:30am–5:00pm, Monday–Friday.
Member Facing The job duties do not involve face-to-face contact with members, even for staffing purposes.
Education Required Education (must Have)
Bachelor’s degree or equivalent experience within healthcare project management, HEDIS and STARs measures, population health, and the health plan space
Desired Education (nice To Have)
Master’s degree within healthcare management and administration, public health, business administration or relevant field
MA Health Enrollment (required if licensed in Massachusetts)
Note:
No, this is not required for the job.
Experience Required Experience (must Have)
5+ years of experience working within community-based health and/or managed care
Desired Experience (nice To Have)
Experience leading Network projects, clinical implementation, and/or population health initiatives within a community-based health or health plan organization
Knowledge, Skills & Abilities
Strong organizing skills and analytic capabilities
Understanding of duals programs and Network quality measures
Analytic mindset with ability to work with large data sets to identify trends and provide actionable recommendations
Experience with HEDIS and Health Plan quality initiatives; familiarity with behavioral health KPIs such as IET and FUH
Results-oriented and self-motivated; able to work independently and collaboratively across stakeholders
Ability to thrive in high-pressure environments, adjust to shifting priorities, and multi-task
Working knowledge of project/program management practices
Strong verbal communication skills; able to present data insights and facilitate meetings
Proficiency with spreadsheets and databases, including Excel, PowerPoint, and Word
Team player with ability to pivot to meet Network performance goals
Language
English
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Information Technology
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at Commonwealth Care Alliance. Get notified about new Network Analyst jobs in Boston, MA.
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The HEDIS Network Analyst will support CCA’s ability to meet and surpass critical Quality benchmarks and optimize member outcomes as measured through critical measures. The role supports efforts of the Network and Provider Contracting department and will have regular interaction with internal Clinical, Quality, and BI departments, while frequently interfacing with Providers within CCA’s Network. The objective of this role is to reduce and/or prevent loss of revenue due to below-benchmark performance on critical Quality measures. Priority measures may shift year-to-year as dictated by organizational performance trends and the Network’s ability to impact these trends. The role’s three key areas of focus are:
Identify underperforming Providers
Work cross-functionally to determine reasonable expectations and solutions
Facilitate and implement Provider specific and/or Network improvement initiatives
Current year priority measures include Initiation and Engagement of Alcohol or Other Dependence Treatment (IET) and Follow-Up after Hospitalization for Mental Illness (FUH). The ideal candidate will have strong organizing skills, analytic capabilities, and the ability and comfort with working across internal and external stakeholders to coordinate initiatives and projects affiliated with Quality performance improvement.
Essential Duties & Responsibilities
Conduct weekly tracking of Quality/HEDIS metrics, specifically focused on IET and FUH data.
Work with BI, Quality, and BH teams to evaluate and build data sources delivering accurate performance data and reliable actionable data.
Track performance trends on a weekly basis, evaluating member-specific and provider-level details.
Identify reasons for low and high performance; determine which providers are performing well or struggling; analyze which diagnosis settings lead to missed opportunities for timely Initiation visits.
Identify which Network providers are excelling and which are underperforming.
Design IET and FUH data formats that are user-friendly and can be shared with relevant Network Providers (including those with delegated arrangements).
Review YTD claims files on a monthly/quarterly basis to identify errors and address accordingly with appropriate SMEs.
Meet with select Providers and HHs to discuss IET and FUH performance and workshop improvement interventions with short-term and long-term goals.
Understand barriers and challenges providers are experiencing; work with high performers to build tips and best practices for lower performing entities and internal teams.
Determine regular cadence to check in with lower performing HHs and Providers to monitor progress.
Partner with CCA Clinical teams and programs to roll out initiatives aimed at leveraging Providers to improve Quality measures.
Train and educate Provider Network on the measures by organizing trainings, building reference documents, and creating webinars; ensure materials are appropriate for different Provider audiences.
Working Conditions
This is a remote role with standard operating hours of 8:30am–5:00pm, Monday–Friday.
Member Facing The job duties do not involve face-to-face contact with members, even for staffing purposes.
Education Required Education (must Have)
Bachelor’s degree or equivalent experience within healthcare project management, HEDIS and STARs measures, population health, and the health plan space
Desired Education (nice To Have)
Master’s degree within healthcare management and administration, public health, business administration or relevant field
MA Health Enrollment (required if licensed in Massachusetts)
Note:
No, this is not required for the job.
Experience Required Experience (must Have)
5+ years of experience working within community-based health and/or managed care
Desired Experience (nice To Have)
Experience leading Network projects, clinical implementation, and/or population health initiatives within a community-based health or health plan organization
Knowledge, Skills & Abilities
Strong organizing skills and analytic capabilities
Understanding of duals programs and Network quality measures
Analytic mindset with ability to work with large data sets to identify trends and provide actionable recommendations
Experience with HEDIS and Health Plan quality initiatives; familiarity with behavioral health KPIs such as IET and FUH
Results-oriented and self-motivated; able to work independently and collaboratively across stakeholders
Ability to thrive in high-pressure environments, adjust to shifting priorities, and multi-task
Working knowledge of project/program management practices
Strong verbal communication skills; able to present data insights and facilitate meetings
Proficiency with spreadsheets and databases, including Excel, PowerPoint, and Word
Team player with ability to pivot to meet Network performance goals
Language
English
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Information Technology
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at Commonwealth Care Alliance. Get notified about new Network Analyst jobs in Boston, MA.
#J-18808-Ljbffr