Senior Clinical Healthcare Analyst - (Quality/Risk Adjustment)
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
***This is a remote working opportunity***
Position Purpose: Reporting to the Director of Analytics, the Clinical Healthcare Analyst will demonstrate strong knowledge of performance indicators and develop key business insights into quality and risk adjustment performance that will inform the quality improvement strategy.
- Responsible for maintenance, support and HEDIS coding, to include validation of external vendor solutions required to report performance rates to target for appropriate quality measures across all Steward Commercial, Medicare, and Medicaid risk contracts
- Collaborate with the Performance Operations teams to provide analytics support of measure performance within SHCN value-based contracts that range from NCQA HEDIS measures to CMS ACO to patient experience of care survey data to risk contract custom measures
- Leads the SHCN Informatics partnership to automate existing quality and risk adjustment dashboards and scorecards
- Ensure maximum level of data accuracy, integrity, consistency, and completeness in the various internal and external data sources used for end-user reporting purposes. Data sources include EMR, survey data and claims/enrollment data from Enterprise Data warehouse
- Applies statistical models to support key business solutions
- Proactively identify and investigate complex suspect areas regarding gaps in care
Education / Experience / Other Requirements
- Bachelor's degree required; Master's preferred
Years of Experience:
- 3-5 years of experience required, in health care quality data analysis in either a health plan setting or health system setting that included HEDIS claims coding and working with NCQA HEDIS measures.
- Additional knowledge of risk coding models
- Strong understanding of statistical concepts and SQL programming knowledge
- Intermediate to advanced level of BI visualization experience, preferably in tableau
- Data science applications (e.g. R, Python, etc.) to build predictive models
- Strong analytic skills/ability to translate complicated data into useable information, including analysis of practice variation
- Strong leadership skills and the ability to manage user expectations
- Ability to generate creative solutions
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.
Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:
- Any COVID-19 related care takes place in designated areas away from other patients and their families.
- A stringent cleaning policy has been implemented throughout our facilities.
- A strictly controlled visitor and masking policy is required for patient and colleague safety.
You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.