Senior Quality Analyst

🕒 Março 13

🏄 California – Remoto

🏄 California – Remote

💵 $71.700 - $103.732 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

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SCAN

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1977

⚕️ Seguro de Saúde

👥 B2C

Healthcare Insurance • B2C

A SCAN é uma organização de saúde orientada por uma missão, focada em reinventar o envelhecimento ao fornecer cuidado e cobertura centrados no paciente e baseados em evidências para idosos. Ela opera um portfólio integrado que inclui planos de seguro de saúde com benefícios inovadores, atendimento primário domiciliar e virtual, programas de apoio para cuidadores e idosos confinados em casa, além de serviços especializados para populações vulneráveis. A SCAN também investe e faz parcerias com empresas que avançam nos modelos de cuidado e recursos para ajudar os idosos a se manterem saudáveis e independentes em casa.

Descrição

• Monitor, analyze, and develop insights on STAR measure performance for HEDIS, CAHPS, HOS, Pharmacy (PQA), and Operational measures. • Perform root-cause analysis to identify drivers of performance gaps and recommend targeted interventions. • Partner with Health Care Informatics and other internal analytics team to ensure dashboards, scorecards, and routine performance reports for leadership and operational partners. • Model future projections and perform “What-if” scenarios for STAR rating forecasts. • Conduct routine process analysis for department’s operating procedures and validate compliance with regulatory requirements or develop details assessment outlining gaps/risks identified with proposed process redesigns to mitigate identified gaps and risks. • Collaborate with internal teams (Clinical Operations, Pharmacy, Member Experience, Network, Provider Relations) to design and implement quality improvement strategies. • Track performance of interventions and provide data-driven insights on progress and effectiveness. • Conduct Star competitor analysis and develop insights for all SCAN markets, potential partnerships, or growth opportunities. • Work with IT and data teams to enhance data infrastructure and ensure data quality for STAR reports, and troubleshoot data discrepancies. • Support the design and evaluation of interventions aimed at improving provider performance, member satisfaction, and clinical outcomes.

🎯 Requisitos

• Experience as a Senior Quality Analyst within a health plan or healthcare organization working with a STAR program is highly desirable. • Bachelor's Degree or equivalent experience required. • Master’s degree in a related field preferred. • Experience working within a health plan STAR team. • Familiarity with claims, encounter, and EMR data. • Experience supporting provider engagement or quality improvement initiatives. • Strong knowledge of CMS STAR Ratings methodology, HEDIS measures, CAHPS, HOS, and Medicare Advantage quality programs. • Advanced proficiency in data analysis tools (Excel, SQL, Python, SAS, R, Tableau, or Power BI). • Proficient with MS Office (Access, Word, Excel, PowerPoint) and e-mail. • Ability to communicate complex analytical information to diverse audiences. • Analytical Thinking and Problem-Solving - excel in breaking down complex information and deriving actionable insights. • Strong organizational and project management skills. • Ability to work independently and in a team environment. • Strong team player. • Ability to work under tight deadlines & manage multiple responsibilities independently.

🏖️ Benefícios

• Internal title: STARS Quality Analyst Sr • Work Mode: Mostly Remote • An annual employee bonus program • Robust Wellness Program • Generous paid-time-off (PTO) • 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday • Excellent 401(k) Retirement Saving Plan with employer match and contribution • Robust employee recognition program • Tuition reimbursement • An opportunity to become part of a team that makes a difference to our members and our community every day!