Principal Quality Analytics Lead

🕒 Junho 3

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Lumeris

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

⚕️ Seguro de Saúde

☁️ SaaS

Healthcare Insurance • SaaS

Lumeris é uma empresa focada em fornecer soluções de cuidados baseados em valor na indústria de saúde. Com mais de uma década de liderança neste campo, a Lumeris faz parcerias com sistemas de saúde para melhorar os resultados dos pacientes e impulsionar o sucesso financeiro por meio de soluções habilitadas por tecnologia. Sua plataforma apoia a gestão da saúde populacional, a transformação da prestação clínica e a contratação de pagadores, oferecendo soluções abrangentes para gestão de pacientes agudos, pós-agudos e de alto risco. A Lumeris é reconhecida por criar economias de custo significativas e alcançar excelentes resultados para os pacientes, incluindo uma classificação de 5 estrelas do CMS para seu Plano de Medicamentos sob Prescrição do Medicare Advantage.

Descrição

• Design, build, and maintain CMS-aligned Stars/HEDIS analytic assets, including dashboards, data extracts, recurring performance views, and executive-ready reporting products. • Translate measure specifications (numerator, denominator, exclusions) into auditable analytic logic and develop member-, provider-, and measure-level views to guide Quality Improvement actions. • Analyze multi-source data (quality, medical, pharmacy, clinical) to establish baselines, detect trends, uncover root causes of performance gaps, and distinguish data issues from operational issues. • Partner with Quality Improvement, Clinical, Pharmacy, and Operations stakeholders to prioritize high-impact opportunities and convert analytic insights into intervention targeting, workflow integration, and measurable gap closure. • Automate and scale recurring quality reporting to reduce manual effort through scalable dashboards, reusable SQL, documented logic, and repeatable processes. • Create and manage validation routines, QA checks, and reconciliation processes to ensure quality reporting is accurate, trusted, reproducible, and audit-ready. • Translate complex technical and measure logic into clear, decision-ready performance narratives for non-technical stakeholders and health plan leadership. • Serve as a senior subject matter expert on Stars, HEDIS, quality measure reporting, and health plan operations, advising on the workflow integration of analytic insights.

🎯 Requisitos

• Bachelor's degree in Mathematics, Computer Science, Epidemiology, Public Health, Healthcare Administration, Data Analytics, or a related field; equivalent experience may be considered. • 7+ years of healthcare analytics experience, with direct experience in Medicare Advantage Stars, HEDIS, quality measures, and health plan performance analytics. • Hands-on experience writing complex SQL and extracting data from large, multi-layered health plan data environments. • Experience building dashboards, recurring reports, or automated reporting processes using Tableau, Power BI, or similar business intelligence tools. • Experience with Stars cut points, HEDIS specifications, CAHPS, medication adherence, clinical quality workflows, or care gap closure. • Ability to translate Stars/HEDIS measure logic into analytic rules, including numerators, denominators, exclusions, and opportunity sizing. • Experience working with healthcare datasets such as claims, eligibility, provider, pharmacy, or clinical data. • Demonstrated ability to self-direct analyses, manage ambiguity, structure complex problems, and deliver actionable insights with limited direction. • Experience using AI-enabled analytics, automation, or natural language tools to accelerate insight generation. • Strong communication skills with the ability to explain technical concepts and recommended actions to non-technical stakeholders. • Advanced degree in Public Health, Epidemiology, Analytics, Computer Science, Healthcare Administration, or a related field.

🏖️ Benefícios

• Medical, Vision and Dental Plans • Tax-Advantage Savings Accounts (FSA & HSA) • Life Insurance and Disability Insurance • Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) • Employee Assistance Program • 401k with company match • Employee Resource Groups • Employee Discount Program • Learning and Development Opportunities • And much more...