Transformation Analyst III

Inland Empire Health Plan•Rancho Cucamonga, CA

7d•$104,042 - $137,842•Hybrid

About The Position

The Transformation Analyst III leads cross-departmental efforts to use financial and/or clinical analytics to develop strategic transformation and health or quality management recommendations, and to implement quality improvement activities. The role supports IEHP compliance standards, strategic goals, and initiatives through stakeholder engagement, technical analysis, evaluation of data sources, visualization tools, and recommendations for business-unit decisions and action plans. The position leads projects involving study development, data collection and analysis, policy interpretation, and policy creation and updates. It serves as a liaison supporting operations, quality improvement initiatives, and studies with leadership teams across the organization and, where applicable, hospital and ancillary providers. The role requires advanced analytical skills, expertise in integrating and preparing varied datasets, designing analytical databases and visualization environments, and communicating results in accordance with IEHP business rules and reporting requirements. The role also supports IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation. It is based on a hybrid schedule: remote on Mondays and Fridays and onsite Tuesday through Thursday in Rancho Cucamonga, California. The stated annual pay range is USD $104,041.60 to $137,841.60.

Requirements

Six or more years of experience in healthcare study development, writing, and analysis, such as quality improvement, patient/provider services, healthcare finance, care management, or related fields.
Demonstrated experience working with complex data systems and datasets.
Experience with electronic medical records, documentation, and reporting/analysis.
A master’s degree in mathematics, statistics, computer science, information systems, business administration, healthcare, or a related field from an accredited institution; alternatively, a bachelor’s degree in one of these fields plus at least two years of hospital or health-plan experience, in addition to the stated minimum experience requirement.
Advanced knowledge and deep understanding of quality compliance standards; internal and external healthcare, hospital, and business operations; available data sources and systems and appropriate analysis criteria; statistical methods, data analysis, and study methodology; relational database structures and design; and department relationships and external partnerships.
Working knowledge of medical terminology, managed care, claims payment processes, and insurance terminology.
Advanced analytical skills, particularly in healthcare services, finance, regulatory interpretation, and problem solving.
Ability to research and analyze data and make sound recommendations.
Excellent verbal and written communication skills.
Advanced skills using Microsoft Suite applications.
Strong attention to detail.
Ability to support IEHP’s efforts to become a 5-Star Health Plan and incorporate LEAN principles into daily work.

Nice To Haves

PMP, Lean Six Sigma, Certified Professional in Healthcare Quality, or another relevant certification.
Valid California Driver’s License.
Knowledge of concepts, practices, and procedures within a healthcare setting.

Responsibilities

Serve as technical lead for developing, preparing, and presenting detailed, complex reports and analyses supporting IEHP strategic transformation and/or Care Continuum improvement programs and initiatives.
Develop new and alternative analytical tools to support current and emerging business-unit requirements.
Lead planning, execution, and analysis of key studies and reports; review data integrity; and design and select performance metrics in collaboration with internal and external business owners.
Develop timely and accurate data-mining techniques for new or existing standardized and ad hoc reports to ensure consistent analytical conclusions.
Lead other team members in analyzing, interpreting, and translating complex data, issues, and trends into strategies and action plans for program development, quality studies, and department projects.
Determine and prioritize requirements gathering, data requests, analysis, interpretation, reasonability checks, and report-format development.
Collaborate with internal and external partners on methodology to ensure requirements and analysis standards are met.
Ensure key studies and reports are accurate, timely, and compliant; identify reporting issues and present mitigation activities.
Lead documentation of analysis and reporting projects to support standard work and replication of processes and results.
Manage assigned projects and communicate with applicable leadership when deadlines or deliverables are at risk.
Ensure continuous evaluation of trends in quality and financial measures and clinical and operational program performance.
Lead assigned performance-improvement efforts.
Lead development of reports, analyses, and other materials for operational meetings, including Joint Operational Meetings as needed.
Recommend development of training materials, communications, and presentations for management audiences.
Maintain knowledge of IEHP business operations relevant to performance, quality, and/or financial improvement studies, action plans, and programs.
Act as a subject matter expert on regulatory requirements, including current NCQA Health Plan Accreditation Standards, and interpret NCQA communications and changes.
Continuously develop knowledge of quality measures and relevant metrics for developing, tracking, and evaluating programs.
Educate others on data results and methodologies from program designs.
Lead preparation of cohesive summaries in presentation formats for internal and external audiences, including committees, stakeholders, the Governing Board, and member and provider communications.
Lead maintenance of department policies, including annual reviews and updates, and ensure policies are accurate and comply with applicable regulatory requirements.
Perform other duties as required to support successful Health Plan operations and department business needs.