Responsible for providing critical analytical support to the Quality Improvement Department; coordinate collection, interpretation and analysis of data; develop and produce reports that monitor and benchmark cost, utilization and other quality and performance indicators; monitor for adverse trends; recommend modifications and corrective action; assist quality improvement project teams in design and implementation.

Duties_test_update

•  Duties may include, but are not limited to, the following:
• Analyze and evaluate various sources of data in support of internal customers to improve quality and further the goals and objectives of the organization.
• Assist with the analysis, and reporting for HEDIS.
•  Researches best practices, national and regional benchmarks, and industry standards.
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
• Provide analytical support to Finance, Health Services and Operations to coordinate the collection, interpretation and analysis of data as directed.
• Develop and produce reports that monitor and benchmark cost, utilization and other quality and performance indicators.
• Monitor for adverse trends; recommend modifications and corrective action.
• Use standardized monitoring tools to oversee quality (e.g., Dashboard, HEDIS, CAHPS, InterQual, QIA templates).
• Offer support as needed to all quality committees.
• Communicates programs, interventions and results to external entities in accordance with applicable program objectives, policies and procedures.
• Completes project-related communication, including member/physician mailings, business plans, graphics, minutes and agendas.
• Support customer understanding of analytical findings through effective presentation of results to individuals and groups.
• Participates in relevant committees and work groups; makes presentations; prepares reports, data or other materials for committee presentation.
• Represents Plan at external work groups and committees. May lead and/or participate in external activities, work groups or committees when applicable.
• Develops and/or maintains relationships with other external organizations to expand key partnerships.
• Participates in departmental evaluation, audit and improvement activities.
• Manages multiple projects by effectively prioritizing work and communicating workload issues to management.
• Performs all other duties as assigned.

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Qual_test

• Experience with MediCal and/or managed care (preferred).
• Personal computer skills with knowledge of Microsoft Office software including proficiency in Word, Excel, PowerPoint, Access and Project.
• Competency in SQL
• Knowledge of accreditation, federal and state regulations/requirements     
• Analytical and problem solving skills.
• Verbal and written communication skills.
• Team player who builds effective working relationships.
• Ability to work independently.
• Organizational skills.
• Ability to analyze, interpret, apply and communicate policies, procedures and regulations

• Bachelor's Degree in related field or an equivalent combination of education and experience with course studies in Computers, Healthcare Management, etc.

• 2 years managed care experience
• Data analysis and data presentation experience

• 3 years managed care experience in data analysis
• Quality management/regulatory experience with increasing responsibility

• All licenses and certificates must be maintained as a condition of employment.
• Valid California Driver License, transportation and automobile liability insurance in limits acceptable to the Gold Coast Health Plan. Must maintain a satisfactory driving record.