Manager, Quality Analytics and Performance Improvement- Remote

Job Description

Job Summary

The Manager, Quality Analytics and Performance Improvement is responsible for leading, organizing and directing Molina's Quality Analytics team. Provides oversight and support in the design and development of reporting solutions to assist HEDIS audit, rate tracking, and Identifying targeted Interventions and tracking outcome. Manages research, development, and completion of special performance improvement projects. Provides technical, functional, and business training to other team members to enable them to perform the tasks required.

• This position will be focused on the Medicare STARS program.  Please highlight your experience on your application.  

ESSENTIAL JOB DUTIES:

• Manage Quality Data and Predictive Intervention Strategy Analytics along with corresponding tracking of progress and impact of such interventions.
• Manage design and development of ad-hoc as well as automated analytical as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare/MMP.
• Work cross functionally with various departments to capture and document requirements, manage report development efforts, and educate users on how to use reports.
• Manage the design and lead development of retrospective HEDIS rate tracking, supplemental data impact reporting and Intervention’s strategy reporting.
• Manage development of Medical Record Review project reporting to track progress and team productivity reporting.
• Develop analysis and reporting related to Managed care data like Medical Claims, Pharmacy, Lab and HEDIS rates.
• Conduct root cause analysis for business data issues, report to leadership the summary of findings and resolutions.
• Provide oversight for team members who work in an agile business environment to derive meaningful information out of complex as well as large organizational datasets through data analysis, data mining, verification, scrubbing, and root cause analysis.
• Support Quality department with HEDIS measure deep dive to support HEDIS audit and revenue at risk reporting.
• Work in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis.
• Analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance.
• Act as a subject matter expert in HEDIS reporting and provide trainings as required. Stay current with NCQA standards and educate team as well as health plan as needed.
• Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
• Manage changes in the Datawarehouse platform and perform transparent upgrades to analytic reporting modules to ensure no impact to the end users.
• Conduct preliminary and post impact analyses for any logic and source code changes for data analytics and reporting module keeping other variables as constant that are not of focus.
• Develop training modules to help analysts understand processes, solutions or designs to meet the customer request for new/existing staff.
• Provide technical, functional, and business trainings to internal and external team members to enable them to perform the required tasks.
• Assist health plans building reporting solutions to perform successful member and provider interventions.
• Maintain a team culture to adopt fast faced agile environment and foster a positive attitude to take on challenging and time sensitive projects.
• Take accountability of tasks and projects to ensure direct reports are meeting the requirements as assigned while maintaining the team productivity standards.
• Performance manage and provide clear direction on how to support and meet the business requirements while maintaining employee engagement.

 

Job Qualifications

REQUIRED EDUCATION:

Bachelor's Degree in Computer Science, Finance, Math or Economics or equivalent discipline

REQUIRED EXPERIENCE:

• 3+ years of Manager/Supervisory or Lead experience
• 7+ Years of experience in working with data mapping, scrubbing, scrapping, and cleaning of data.
• 7+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design