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 recommend strategic transformations and health or quality management improvements, and to implement related quality improvement activities. Reporting to department leadership, the role supports IEHP compliance standards, strategic goals, and initiatives through stakeholder engagement, technical analysis, data-source evaluation, 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 organizational leadership and, when applicable, hospital and ancillary providers. The incumbent integrates and prepares varied datasets, architects analytical databases and visualization environments, and communicates findings in compliance with IEHP business rules and reporting requirements. The position also supports IEHP’s Quality Program goals, including HEDIS, CAHPS, and NCQA Accreditation. It works on strategic transformation and/or Care Continuum improvement programs and initiatives, leads performance improvement efforts, and prepares analyses, reports, and materials for operational meetings and stakeholder audiences. The role is hybrid, with remote work on Mondays and Fridays and onsite work Tuesday through Thursday in Rancho Cucamonga, California.

Requirements

At least six 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 from an accredited institution in mathematics, statistics, computer science, information systems, business administration, healthcare, or a related field; alternatively, a bachelor’s degree in one of these fields plus at least two years of hospital or health plan experience. This experience is in addition to the stated minimum experience requirement.
Advanced knowledge of quality compliance standards and internal and external healthcare/hospital and business operations.
Advanced knowledge of available data sources and data systems and appropriate data-analysis criteria.
Advanced knowledge of statistical methods, data analysis, and study methodology.
Advanced knowledge of relational database structures and database design.
Advanced knowledge of department relationships and external partnerships supporting daily operations.
Working knowledge of medical terminology, managed care, claims payment processes, and insurance terminology.
Advanced analytical skills emphasizing healthcare services, finance, regulatory interpretations, 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 and 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, using available analytical tools and quality improvement methods.
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 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 conclusions.
Lead 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 related to 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, involving the Health Plan, departments, providers, and external stakeholders.
Recommend training materials, communications, and presentations suited to management audiences and deliverables.
Maintain current knowledge of IEHP business operations related 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 about data results and methodologies from various program designs.
Lead the organization of cohesive summaries in presentation formats for internal and external committees and 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 Health Plan operations and department business needs.