Monitor, analyze, and develop insights on STAR measure performance for HEDIS, CAHPS, HOS, Pharmacy (PQA), and Operational measures
Perform root-cause analysis to identify drivers of performance gaps and recommend targeted interventions
Partner with Health Care Informatics and other internal analytics team to ensure dashboards, scorecards, and routine performance reports for leadership and operational partners
Model future projections and perform “What-if” scenarios for STAR rating forecasts
Conduct routine process analysis for department’s operating procedures and validate compliance with regulatory requirements or develop details assessment outlining gaps/risks identified with proposed process redesigns to mitigate identified gaps and risks
Collaborate with internal teams (Clinical Operations, Pharmacy, Member Experience, Network, Provider Relations) to design and implement quality improvement strategies
Track performance of interventions and provide data-driven insights on progress and effectiveness
Conduct Star competitor analysis and develop insights for all SCAN markets, potential partnerships, or growth opportunities
Work with IT and data teams to enhance data infrastructure and ensure data quality for STAR reports, and troubleshoot data discrepancies
Support the design and evaluation of interventions aimed at improving provider performance, member satisfaction, and clinical outcomes
Actively support the achievement of SCAN’s Vision and Goals

Requirements

Experience as a Senior Quality Analyst within a health plan or healthcare organization working with a STAR program is highly desirable
Bachelor's Degree or equivalent experience required
Master’s degree in a related field preferred
Experience working within a health plan STAR team
Familiarity with claims, encounter, and EMR data
Experience supporting provider engagement or quality improvement initiatives
Strong knowledge of CMS STAR Ratings methodology, HEDIS measures, CAHPS, HOS, and Medicare Advantage quality programs
Advanced proficiency in data analysis tools (Excel, SQL, Python, SAS, R, Tableau, or Power BI)
Proficient with MS Office (Access, Word, Excel, PowerPoint) and e-mail
Ability to communicate complex analytical information to diverse audiences
Analytical Thinking and Problem-Solving - excel in breaking down complex information and deriving actionable insights
Strong organizational and project management skills
Ability to work independently and in a team environment
Strong team player
Ability to work under tight deadlines & manage multiple responsibilities independently

Benefits

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisroot-cause analysisSTAR measure performanceHEDIS measuresCAHPSHOSPharmacy (PQA)CMS STAR Ratings methodologyclaims dataEMR data

Soft Skills

analytical thinkingproblem-solvingcommunicationorganizational skillsproject managementteam collaborationindependencetime managementadaptabilityinterpersonal skills