Note: The job is a remote job and is open to candidates in USA. IEHP is a health plan organization seeking a Transformation Analyst III to lead cross-departmental financial and clinical analytics supporting strategic transformation, care continuum, and quality improvement initiatives. The role oversees complex studies and reports, develops analytical tools and databases, interprets regulatory requirements, manages projects, and communicates recommendations to internal and external stakeholders.
Responsibilities
- Serve as technical lead for the development, preparation and presentation of detailed, complex reports and analyses to support IEHP’s Strategic Transformation and/or Care Continuum improvement programs and initiatives utilizing available analytical tools and quality improvement methods. Develop new and alternative analytical tools to support current and emerging business unit requirements
- In support of quality standards, strategic goals, and transformation and/or Care Continuum initiatives for internal teams, and, if applicable, hospitals and ancillary providers, lead planning, execution and analysis of key studies and reports, data integrity review, design and selection of performance metrics while working closely with internal and external business owners
- Develop timely and accurate data mining techniques to apply to new or existing standardized and ad-hoc reports that ensure consistent conclusions to data analysis
- Lead other Team Members in the analysis, interpretation, and translation of complex data, issues and trends into effective strategies and action plans as it relates to program development, quality studies (e.g., effectiveness studies, satisfaction studies) and department projects. Responsibilities include determining and prioritizing requirements gathering, data requests, analysis, interpretation, reasonability checks, and report format development. Collaborate with internal and external partners on methodology to create and ensure requirements and analysis standards are met
- Guarantee key studies and reports are delivered accurately, timely, and meet compliance requirements. Identify reporting issues and present mitigation activities. Lead the documentation of analysis and reporting projects to ensure standard work and replication of processes and results by other team members. Manage assigned projects and effectively communicate with the applicable leadership team if any project deadlines or other deliverables are at risk
- Ensure the department’s continuous evaluation of trends related to quality and financial measures, clinical and operational program performance. Lead assigned performance improvement efforts
- Lead the development of reports, analyses, and other materials for operational meetings (inclusive of Joint Operational Meetings (JOM) as needed) between the Health Plan, departments, providers, and other external stakeholders
- Provide recommendations for the development of training materials, communications, and presentations for various levels of management depending on audience and deliverables
- Maintain updated knowledge of IEHP business operations for performance and quality and/or financial improvement studies, action plans and programs
- Act as Subject Matter Expert of regulatory requirements, including current NCQA Health Plan Accreditation Standards and the ability to interpret NCQA communications and changes. Continuously develop knowledge on quality measures and relevant metrics that may be utilized to develop, track, and evaluate new and existing programs
- Educate others regarding data results and methodologies from various program designs. Lead organization of cohesive summaries in presentation formats presented to various audiences including internal and external Committees and stakeholders, The Governing Board, other member, and provider communication methods
- Lead efforts in maintaining department policies including annual reviews and updates. Ensure policies are accurate and in accordance with applicable regulatory requirements
- Perform any other duties as required to ensure Health Plan operations and department business needs are successful
Skills
- Six (6) or more years of experience in study development, writing and analysis in healthcare (quality improvement, patient/provider services, healthcare finance, care management or related fields) required
- Demonstrated experience working with complex data systems and data sets
- Experience with electronic medical records, documentation, reporting/analysis required
- Master's degree in mathematics, statistics, computer science, information systems, business administration, healthcare or related field from an accredited institution required
- In lieu of the required master's degree, a bachelor's degree in mathematics, statistics, computer science, information systems, business administration, healthcare or related field from an accredited institution and a minimum of two (2) years of hospital or health plan experience is required for this position
- This experience is in addition to the minimum years listed in the Experience Requirements above
- Quality compliance standards, internal and external healthcare/hospital and business operations
- Available data sources and data systems, and appropriate data analysis criteria
- Statistical methods, data analysis, and study methodology
- Relational database structures and database design
- Department relationships and external partnerships to support daily operations
- Working knowledge of Medical terminology and knowledge of managed care, claims payment processes and insurance terminology required
- Advanced analytical skills with emphasis on healthcare services, finance, regulatory interpretations, and problem solving
- Ability to research, analyze data and make sound recommendations. Excellent verbal and written communication skills
- Advanced skills in utilizing Microsoft Suite applications
- Strong attention to detail. Ability to demonstrate a commitment to support IEHP's efforts to become a 5-Star Health Plan and incorporate LEAN principles into daily work
- PMP, Lean Six Sigma, certified professional in Healthcare Quality, or other relevant certification preferred
- Valid California Driver's License preferred
- Concepts, practices, and procedures within a healthcare setting preferred
Benefits
- Work Model: Remote
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
Company Overview