Senior Quality Analyst

🕒 il y a 3 mois

🏄 California – Distant

🏄 California – Remote

💵 $71 700 - $103 732 / an

⏰ Temps Plein

🟠 Senior

🧐 Analyste

🦅 Parrain de Visa H1B

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SCAN

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 1977

⚕️ Assurance santé

👥 B2C

Healthcare Insurance • B2C

SCAN est une organisation de santé axée sur la mission, dédiée à réinventer le vieillissement en fournissant des soins et des couvertures axés sur le patient et basés sur des preuves pour les personnes âgées. Elle exploite un portefeuille intégré comprenant des régimes d'assurance santé avec des avantages innovants, des soins primaires à domicile et virtuels, des programmes de soutien pour les aidants et les personnes âgées confinées à domicile, ainsi que des services spécialisés pour les populations vulnérables. SCAN investit également dans et s'associe à des entreprises qui font progresser les modèles de soins et les ressources pour aider les personnes âgées à rester en bonne santé et autonomes à domicile.

Description

• 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.

🎯 Exigences

• 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.

🏖️ Avantages

• 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!