Business Analyst, Consultant - Quality Performance
About The Position
The Clinical Pharmacy Programs team within the Pharmacy Strategy & Operations department defines and executes strategies addressing clinical quality, member experience, and prescription medication affordability for Blue Shield members. The Business Analyst, Consultant, Rx Quality Performance Management supports development, measurement, and continuous improvement of Pharmacy initiatives across Commercial and Medicare lines of business. The role combines performance analytics, program management, member experience insights, and executive reporting to identify opportunities, measure outcomes, and drive member-centered improvements. The position provides complex analytical and project support, contributes to planning and business cases, and develops reporting for management. It expands expertise in monitoring drug quality and member experience measures and works with internal and external data and technology partners. The role reports to the Senior Manager, Rx Member Experience & Quality Performance and requires independent work with limited oversight. This is a hybrid role. For most teams, the workplace model means working in the office two days each week. Employees living more than 50 miles from an office location work with their manager to determine in-office time based on business need. The work is performed in an office or home-office/deskwork environment, with a sedentary activity level for most of the workday.
Requirements
- Bachelor’s degree or equivalent experience.
- At least 7 years of prior relevant experience.
- Strong analytical and problem-solving skills.
- Intermediate to advanced knowledge of pharmacy data elements and related technical standards and concepts, such as claims, e-prescriptions, e-prior authorization, and real-time pharmacy benefits.
- Advanced proficiency in Microsoft Word, Excel, PowerPoint, OneNote, and SharePoint.
- Excellent written, verbal, and interpersonal communication skills.
- Experience working independently in a fast-paced environment.
Nice To Haves
- At least 3 years of experience in managed care.
- Experience with HEDIS, CAHPS, NPS, and Medicare Stars data.
Responsibilities
- Provide highly complex analytical support by analyzing and interpreting data for cross-functional business operations.
- Lead development of annual operating plans, capital budgets, and forecasts, and build cost-benefit business cases for new business initiatives.
- Develop, prepare, and analyze reports involving highly complex analysis and data for management review, and present findings to various levels of management.
- Define business requirements and provide analysis to increase operational efficiency.
- Provide analytical support for multiple highly complex cross-functional projects simultaneously; establish work plans and timelines and coordinate internal and external resources.
- Expand subject matter expertise in monitoring drug quality and member experience performance measures to support program improvement and enterprise goals.
- Establish and sustain collaborative relationships and an operating model with internal and external data and technology partners to ensure robust management of drug quality performance.
- Work independently with limited oversight to achieve goals and objectives.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
