Lead Quality Data Analyst - Remote

Summary of Job

Lead and develop meaningful insights, actionable analytics and applicable plans and /or corrective actions through appropriate advanced statistical and/or modeling analyses. Incorporate diverse data sources across internal and external platforms to continuously improve the plan's healthcare qualitymetric performance (HEDIS/QARR/Star/Accreditation) to drive quality improvement initiatives/projects. Identify improvement opportunities and provide guidance for needed changes. Provide support in the satisfaction of internal and external requirements in support of EmblemHealth's HEDIS/QARR metric improvement and reporting responsibility. Prepare and present analytical dashboards and data to key stakeholders to support strategic decision making.

Responsibilities

• Lead the development of complex and/or advanced statistical/modeling analyses of quality metrics for Medicare, State Sponsored Programs, and other populations.
• Develop and maintain quality dashboards and measure profiles utilizing data visualization tools.
• Analyze monthly rate reports and stratify data to identify statistically significant trends.
• Perform monthly rate/impact /trending analysis and recommend corrective actions to meet quality targets.
• Conduct evaluation studies and root-cause analyses to identify improvement area(s) and understanding of the marketplace. Evaluate program effectiveness for complex quality improvement projects. Provide analytical and evaluation guidance to internal department for simple projects.
• Generate population or targeted profiles with frequency, categorical, and spatial analyses.
• Perform exploratory and in-depth data analyses for assigned measure/population and develop complex predictive models utilizing independent variables and programming language.
• Develop customized models and scenario analyses to monitor and review projected measure scores/incentive results through the year. Lead and take corrective actions to meet established goals and/or overall quality metric goals.
• Create, design, and implement new analytics tools and visualizations to supplement and support decision-making for departmental activities.
• Identify data improvement opportunities through review of HEDIS/QARR/Star reports and data outputs and detecting data acquisition, capture, and system error issues.
• Maintain up-to-date knowledge and understanding of HEDIS/QARR/Star measure technical specifications.
• Support quality specific interoperability efforts.
• Support quality specific regulatory needs.
• Collaborate with internal quality management teams to assist on quality improvement initiatives.
• Provide analytical and technical support for design, development and maintenance of quality improvement and wellness initiatives.
• Develop additional elements to prepare plan-specific and provider-specific reports/information related to quality, services, and other areas.