Health Services Evaluator - Quality Systems

Inland Empire Health Plan•Rancho Cucamonga, CA

8d•Hybrid

About The Position

Under the direction of the Manager of Health Services Evaluation, the Health Services Evaluator - Quality Systems will support the development, implementation and evaluation of intermediate to moderate levels of complex technical and analytical research and quality improvement projects to support the quality improvement efforts at IEHP. The Health Services Evaluator - Quality Systems will measure the effectiveness of programs in alignment with the organizational mission, vision, and values. The person in this role will support the design, implementation, and evaluation of programs across departments and provide expertise in designing and developing program evaluation tools, collecting, and analyzing program data, interpreting findings, and recommending program changes. The Health Services Evaluator - Quality Systems will work with a team of evaluators, data analysts, and healthcare informatics specialists to model complex healthcare related problems, discover insights and identify opportunities through the use of statistical, algorithmic, mining and visualization techniques to support business decision-making. Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

Minimum of two (2) years of program evaluation experience with relevant quantitative and qualitative research and analytics experience
Extensive utilization experience in Microsoft Access, SAS, and Excel are essential
Doctoral degree in Public Health or related field from an accredited institution is required
One (1) of the following scenarios will be accepted in lieu of a Doctoral Degree:
Candidates with near completion of their Doctoral Degree in the field of Public Health or related field will be required to complete Doctoral Degree within twelve (12) months of hire
In lieu of a Doctorate degree, a minimum of a Master's degree and two (2) years of additional relevant work experience is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above
Proficiency using statistical packages (such as SAS, SPSS, R, Microsoft Access) and in statistical analysis, quantitative and qualitative analytics, forecasting/predictive analytics, multivariate testing, and optimization algorithms
In-depth knowledge in program and evaluation design and data collection and analysis
Familiarity with and ability to learn ICD-9/ICD-10/CPT/HCPCS/NDC medical coding, medical terminology, and knowledge of managed care, claims payment processes and insurance terminology
Compliance with Healthcare Regulations. Knowledge of HIPAA.
Medical Coding and Billing
Good communication and interpersonal skills required
Computer (Microsoft Office)
Business Acumen
Communication (Written and Verbal)
Data Analysis
Interpersonal Networking
Research and Statistics
Critical Thinking
Oral Presentation
Professional demeanor for interacting with business units, senior leaders, and external stakeholders
The ability to inform solutions to loosely defined business problems
Demonstrate ability to think creatively and critically and apply theoretical knowledge into practice
Manage multiple projects and requests in a time-sensitive and deadline-driven environment
Strong attention to detail

Nice To Haves

Experience in the healthcare field is preferred.
Experience in program development, implementation, and/or management is preferred

Responsibilities

Evaluate the effectiveness of programs and service delivery through outcome monitoring and data analysis.
Compare desired and actual program outcomes and suggest changes based on findings
Develop and facilitate new and ongoing processes in all areas of program evaluation, serving as lead evaluator of small- and large-scale projects.
Responsible for providing expertise in program design, implementation, and revision, with a focus on evaluating outcomes
Work closely with business units across the organization to make data-informed decisions regarding programs. This includes designing and implementing studies, conducting quantitative and qualitative data collection and analysis, performing descriptive and inferential statistics, writing reports, and disseminating findings for multiple audiences
Support the collaborative work of Quality Systems in a variety of evaluation, data collection, analysis, and reporting tasks, including preparing presentation and written materials for reports, regulatory requirements, Quality Programs, audits, and internal and external stakeholder meetings
Must have advanced analytic skills to contribute to the integration and preparation of large, varied datasets, work in specialized databases and computing environments, and communicate results which are compliant with IEHP business rules and reporting requirements
Serve as the project lead on moderately complex analysis/reporting projects and multi-departmental projects assigned to the Health Services Evaluation Unit.
Responsible for coordinating and managing all aspects of program evaluation, program effectiveness studies, data analysis, and related support tasks, including the collaborative efforts of multiple teams
Model and frame business scenarios that will have meaningful impact on critical business processes and/or decisions for the health services department and other departments across the organization
Acquire and maintain updated knowledge of the various data sources available within IEHP for reporting, as well as a clear understanding of IEHP business operations, to be able to appropriately apply criteria and methodology to meet requestors’ needs
Collaborate with staff at all levels to solve analytics issues, documenting results and methodologies
Coordinate and manage the collection, delivery, entry, verification, analysis, and reporting of data that support Health Services initiatives
Collaborate with data teams to ensure that information used follows the organization’s compliance, access management, and control standards
Provide support to the ongoing tracking and monitoring of the performance of decision systems and statistical models that support Health Services initiatives
Demonstrate proficiency in use of statistical software to analyze complex data and interpret results
Plan and coordinate all aspects of major research programs across multiple clinical departments at IEHP.
Support inter-disciplinary, inter-institutional, and inter-sectoral research collaborations
Apply specialized knowledge and scientific principles to review, critically appraise and interpret published literature