Job Summary
The Director, Quality Analytics and Performance Improvement is a key leader within the organization. Responsible for leading, organizing and directing Molina’s national Quality Analytics team. Leads team that is building various reporting solutions around quality including but not limited to rate tracking, HEDIS audit support, medical record retrieval project tracking, and building targeted interventions strategy reporting and outcome tracking. This position will direct team to collect, validate, analyze, and organize data into meaningful reports for management decision making as well as designing, developing, testing and deploying reports to end users for operational and strategic analysis.
JOB DUTIES (Main duties & responsibilities of the role):
- Works with senior executives, Vice Presidents and AVPs across the enterprise and health plan quality teams to determine all aspects of HEDIS/Quality reporting and analysis needs.
- Acts as subject matter expert on healthcare quality reporting and analytics, mentors, coaches, and provides guidance to team regarding healthcare Quality reporting and analytics. Stays current with NCQA standards and educates teams as needed.
- Collaborates and aligns with IT reporting team to create quality data infrastructure to support quality measurement, performance improvement, strategic interventions and reporting activities.
- Sets goals and plans of reporting and analytics business unit in alignment with the operating plan, budget, and regulatory requirements.
- Sets direction of reporting design, nomenclature, approach, requirements gathering, end-user communications protocols, release schedules and change management process
- Identifies opportunities to improve report development process to meet development, UAT and production standards.
- Sets direction of reporting quality assurance process to minimize end-user error identification
- Ultimately responsible for quality assurance for all reports generated by staff reporting to this position
- Implements strategies to ensure service level benchmarks for report turn-around are met. Demonstrates best practices and collaboration on projects.
- Direct team to analyze data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilize extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance.
- Assist with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.
- Tracks and manages requests in Jira to ensure all deliverables are closely monitored, manages team productivity and ensures work is distributed to the team evenly.
Job Qualifications
REQUIRED EDUCATION:
Bachelor’s degree in Computer Science, Finance, Math, Economics or Analytics or equivalent discipline
REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:
• 5+ years of experience managing large Quality/HEDIS analytics team.
• 7+ Years of experience in Managed Care Organization executing similar techno functional role that involves writing complex SQL Queries, Functions, Procedures and Data design
• 8+ Years of experience in working with relational databases.
• 8+ years of experience in working with Microsoft T-SQL, SSIS, SSRS and Power BI
• Familiarity with Data Science Techniques and languages like Python and R programming
• Solid understanding of Microsoft Azure, AWS, or Hadoop technology.
• 5+ Years of experience with predictive modeling in healthcare quality data.
• 5+ Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among Medicaid, Marketplace and Medicare/MMP.
• 5+ Years of experience in working with increasingly complex data problems in quantifying, measuring, and analyzing financial/performance management and utilization metrics.
• 5+ Years of experience in Statistical Analysis and forecasting of trends in HEDIS rates to provide analytic support for quality, finance, and health plan functions
PREFERRED EDUCATION:
Clinical degree or advanced IT degree or advanced public health or health care administration degree preferred
PHYSICAL DEMANDS:
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
