Manager, Clinical Quality Analytics

Job Summary

The Manager of Clinical Quality Analytics (MSA) is responsible for the operations, projects and planning of the reporting and analytics on quality programs for all of L.A. Care’s line of business (LOB) which includes Medicare Stars, Exchange Quality Rating Systems and MediCal’s Managed Care Accountability Sets, and other data-sharing and/or quality improvement programs focused on enhancing member experience and quality of life. The MCQA is responsible for analyzing, monitoring, reporting, and providing technical collaboration and data driven decision making on clinical and operational quality improvement activities related to these programs. The MCQA recommends policies, and leads process improvement efforts.

Additionally, the MCQA works with the Quality Improvement team, department leadership, and the provider network on developing plan-wide quality improvement and data strategy activities. The MCQA assists in developing a long-term plan for analytics and evaluation activities to support the quality improvement strategy and goals, including enterprise wide data and analytics solutions. The MCQA manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct and indirect staff reports.

Duties

Leverage data to inform targeted strategies that indicate whom to engage, with what content and through which channel and frequency: prioritize members and providers based on characteristics, such as RAF scores, open care gaps and quality improvement performance to enable a targeted and tailored outreach for members and providers through preferred channels - web, print, email, etc.

Implement a data-driven quality improvement strategy and predictive model to prioritize a set of measures that will drive higher quality ratings.  Evaluate measures on a regular schedule to accommodate quality improvement performance changes throughout the year. These insights will enable accountable entities to make in-flight adjustments as needed, throughout the measurement year.

Establish streamlined and accurate process for quality improvement performance scorecards at the contract, provider and member level along with predictive analytics models. Work closely with QPM, HIM and other analytics teams and vendors to ensure provider web based quality tools used to monitor performance and close diagnosis and care gaps are complete, accurate, and timely and provide actionable insights at the member level.

Develop meaningful dashboards, reports, tools, and presentations to inform and influence Stars strategy and related activities.

Act as an analytics and technical subject matter expert on teams working on development and execution of Stars strategic initiatives.

Work closely with Quality Improvement team to manage and lead quality reporting and analytical strategies to enable accountable entities and stakeholders to drive quality ratings improvement for CAHPS, HOS, HEDIS, Medication Adherence and Plan Operations

Manage staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Perform other duties as assigned.

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 6 years of experience in HEDIS, quality improvement, risk adjustment analytics, research, or related work within a healthcare context.

At least 4 years leading staff or supervisory/management experience.

Experience working with complex data sets.

Experience with developing reports in Tableau, SQL and developing datasets and data marts. 

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Skills

Required:

Ability to effectively collaborate and support cross functional department leadership.

Strong understanding of health care quality reporting programs, specifically Medicare Stars and HEDIS and health plan regulatory reporting requirements.

High degree of initiative and motivation.

Strong understanding of best practices in data visualization including Tableau

Strong understanding of value-based payment concepts and related engagement strategies.

Knowledge of SQL coding.

Knowledge of managed care concepts and principles and basic health plan operations.

Excellent analytical, problem solving and decision-making skills.

Ability to manage multiple tasks and projects and to delegate.

Excellent reading, oral and written communication and interpersonal skills.

Ability to work independently.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information