Transformation Analyst III

Inland Empire Health Plan•Rancho Cucamonga, CA

10d•$104,042 - $137,842•Remote

About The Position

Reporting to department leadership, the Transformation Analyst III leads cross-departmental efforts to utilize financial and/or clinical analytics to make strategic transformation recommendations and/or health/quality management recommendations, as well as implement quality improvement activities based on those analytics that revolutionize IEHP compliance standards, strategic goals, and initiatives. Key activities include engaging with stakeholders to develop and execute technical analyses, evaluating existing data sources, creating visualization tools, and recommending strategic business unit decisions and action plans. This position leads projects supporting key deliverables including study development, data collection, data analysis, policy interpretation, and policy creation and updates. The incumbent acts as the main liaison to support operations, quality improvement initiatives, and studies with leadership teams across the organization and, if applicable, hospital and ancillary providers. In addition to advanced analytical skills, the Transformation Analyst III displays expertise at integrating and preparing varied datasets, architecting analytical databases and visualization environments, and communicating results that are compliant with IEHP business rules and reporting requirements. 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

Six (6) or more years of experience in study development, writing and analysis in healthcare (quality improvement, patient/provider services, healthcare finance, care management or related fields) required
Demonstrated experience working with complex data systems and data sets
Experience with electronic medical records, documentation, reporting/analysis required
Master’s degree in mathematics, statistics, computer science, information systems, business administration, healthcare or related field from an accredited institution required
In lieu of the required master’s degree, a bachelor’s degree in mathematics, statistics, computer science, information systems, business administration, healthcare or related field from an accredited institution and a minimum of two (2) years of hospital or health plan experience is required for this position
This experience is in addition to the minimum years listed in the Experience Requirements above
Advanced knowledge and deep understanding of: Quality compliance standards, internal and external healthcare/hospital and business operations
Available data sources and data systems, and appropriate data analysis criteria
Statistical methods, data analysis, and study methodology
Relational database structures and database design
Department relationships and external partnerships to support daily operations
Concepts, practices, and procedures within a healthcare setting preferred.
Working knowledge of Medical terminology and knowledge of managed care, claims payment processes and insurance terminology required
Advanced analytical skills with emphasis on healthcare services, finance, regulatory interpretations, and problem solving
Ability to research, analyze data and make sound recommendations.
Excellent verbal and written communication skills
Advanced skills in utilizing Microsoft Suite applications
Strong attention to detail.
Ability to demonstrate a commitment 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 other relevant certification preferred

Responsibilities

Serve as technical lead for the development, preparation and presentation of detailed, complex reports and analyses to support IEHP’s Strategic Transformation and/or Care Continuum improvement programs and initiatives utilizing available analytical tools and quality improvement methods.
Develop new and alternative analytical tools to support current and emerging business unit requirements.
In support of quality standards, strategic goals, and transformation and/or Care Continuum initiatives for internal teams, and, if applicable, hospitals and ancillary providers, lead planning, execution and analysis of key studies and reports, data integrity review, design and selection of performance metrics while working closely with internal and external business owners.
Develop timely and accurate data mining techniques to apply to new or existing standardized and ad-hoc reports that ensure consistent conclusions to data analysis.
Lead other Team Members in the analysis, interpretation, and translation of complex data, issues and trends into effective strategies and action plans as it relates to program development, quality studies (e.g., effectiveness studies, satisfaction studies) and department projects.
Responsibilities include determining and prioritizing requirements gathering, data requests, analysis, interpretation, reasonability checks, and report format development.
Collaborate with internal and external partners on methodology to create and ensure requirements and analysis standards are met.
Guarantee key studies and reports are delivered accurately, timely, and meet compliance requirements.
Identify reporting issues and present mitigation activities.
Lead the documentation of analysis and reporting projects to ensure standard work and replication of processes and results by other team members.
Manage assigned projects and effectively communicate with the applicable leadership team if any project deadlines or other deliverables are at risk.
Ensure the department’s continuous evaluation of trends related to quality and financial measures, clinical and operational program performance.
Lead assigned performance improvement efforts.
Lead the development of reports, analyses, and other materials for operational meetings (inclusive of Joint Operational Meetings (JOM) as needed) between the Health Plan, departments, providers, and other external stakeholders.
Provide recommendations for the development of training materials, communications, and presentations for various levels of management depending on audience and deliverables.
Maintain updated knowledge of IEHP business operations for performance and quality and/or financial improvement studies, action plans and programs.
Act as Subject Matter Expert of regulatory requirements, including current NCQA Health Plan Accreditation Standards and the ability to interpret NCQA communications and changes.
Continuously develop knowledge on quality measures and relevant metrics that may be utilized to develop, track, and evaluate new and existing programs.
Educate others regarding data results and methodologies from various program designs.
Lead organization of cohesive summaries in presentation formats presented to various audiences including internal and external Committees and stakeholders, The Governing Board, other member, and provider communication methods.
Lead efforts in maintaining department policies including annual reviews and updates.
Ensure policies are accurate and in accordance with applicable regulatory requirements.
Perform any other duties as required to ensure Health Plan operations and department business needs are successful.