In addition, the Quality Improvement Data Analyst will assist the Director of Quality Improvement with Quality Improvement Projects, HEDIS, CAHPS and other request or mandates. The position will assist in data analysis to determine subjects suitable for the implementation of a QI Project and will lead re-measurement efforts to determine effectiveness.

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Duties may include, but are not limited to, the following:
Analyze and evaluate various sources of data in support of internal customers to improve quality and further the goals and objectives of the organization.
Assist with the analysis, and reporting for HEDIS.
Researches best practices, national and regional benchmarks, and industry standards.
Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
Provide analytical support to Finance, Health Services and Operations to coordinate the collection, interpretation and analysis of data as directed.

Develop and produce reports that monitor and benchmark cost, utilization and other quality and performance indicators.
Monitor for adverse trends; recommend modifications and corrective action.
Use standardized monitoring tools to oversee quality (e.g., Dashboard, HEDIS, CAHPS, InterQual, QIA templates).
Offer support as needed to all quality committees.
Communicates programs, interventions and results to external entities in accordance with applicable program objectives, policies and procedures.
Completes project-related communication, including member/physician mailings, business plans, graphics, minutes and agendas.

Support customer understanding of analytical findings through effective presentation of results to individuals and groups.
Participates in relevant committees and work groups; makes presentations; prepares reports, data or other materials for committee presentation.
Represents Plan at external work groups and committees. May lead and/or participate in external activities, work groups or committees when applicable.
Develops and/or maintains relationships with other external organizations to expand key partnerships.

Participates in departmental evaluation, audit and improvement activities.
Manages multiple projects by effectively prioritizing work and communicating workload issues to management.
Performs all other duties as assigned.

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Knowledge, Skills, and Abilities

Experience with MediCal and/or managed care (preferred).
Personal computer skills with knowledge of Microsoft Office software including proficiency in Word, Excel, PowerPoint, Access and Project.
Competency in SQL
Knowledge of accreditation, federal and state regulations/requirements

Analytical and problem solving skills.
Verbal and written communication skills.
Team player who builds effective working relationships.
Ability to work independently.
Organizational skills.
Ability to analyze, interpret, apply and communicate policies, procedures and regulations

Required Education

Bachelor’s Degree in related field or an equivalent combination of education and experience with course studies in Computers, Healthcare Management, etc.

Required Experience

2 years managed care experience
Data analysis and data presentation experience

Preferred Experience

3 years managed care experience in data analysis
Quality management/regulatory experience with increasing responsibility

Licenses and Certificates

All licenses and certificates must be maintained as a condition of employment.
Valid California Driver License, transportation and automobile liability insurance in limits acceptable to the Gold Coast Health Plan. Must maintain a satisfactory driving record.

Entry level Job Test17031 Job ID- 1099

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