Hospital Systems Analyst II - Hospital Relations

Position Summary/Position

Under the direction of the Clinical Director, Hospital Relations, the Hospital Systems Analyst II - Hospital Relations supports departmental efforts to utilize clinical analytics to make health/quality management recommendations, as well as implement quality improvement activities based on those analytics that advance IEHP compliance standards, strategic goals, and initiatives. Key activities include leading the development, preparation and presentation of quality studies, analyses and reports focused on hospital performance.  Manage project deliverables that support key regulatory deliverables including study development, data collection, data analysis, policy interpretation, policy creation and updates. Work closely with leadership teams across the organization and at provider hospitals in support of quality improvement initiatives and studies. In addition to advanced analytical skills, the Hospital Systems Analyst II - Hospital Relations will display aptitude 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.

Major Functions (Duties and Responsibilities)

1. Lead the development, preparation and presentation of reports and analyses to support IEHP’s Hospital Relations quality improvement programs utilizing available analytical tools and quality improvement methods.
2. In support of quality standards, strategic goals, and initiatives for hospitals, is responsible for the development of key studies and reports, data review, design and selection of performance metrics while working closely with internal and external business owners. These activities include understanding the quality compliance standards, internal and external healthcare/hospital and business operations, knowledge of available data sources and systems, and appropriate data analysis criteria.
3. 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.
4. Serve as Lead Analyst in the analysis, interpretation, and translation of complex data, issues, trends, and action plans as it relates to program development, quality studies (e.g., effectiveness studies, satisfaction studies) and department priorities. Responsibilities include 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.
5. Ensure key studies and reports are delivered accurately, timely, meeting compliance requirements. Responsible for managing assigned projects and effectively communicating with the Hospital Relations leadership team if any project deadlines or other deliverables are at risk.
6. Assist the department in ensuring continuous evaluation of trends related to quality measures, clinical and operational program performance. Participates in performance improvement efforts, as directed.
7. Assist in the development of reports, analyses, and other materials for Joint Operations Meetings (JOM) between the Health Plan and hospitals, other providers, or external stakeholders. 
8. Assist in the development of training materials, communications, and presentations for various levels of management depending on audience and deliverables.
9. Maintain updated knowledge of IEHP business operations for performance and quality improvement studies, action plans and programs.  
10. Maintain knowledge of current NCQA Health Plan Accreditation Standards and the ability to interpret NCQA communications and changes. Develop knowledge base on quality measures and relevant metrics that may be utilized to develop, track, and evaluate new and existing programs. 
11. Effectively understand data results from various program designs and organize 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.
12. Assist in leading the efforts in maintaining the Hospital Relations department policies including annual reviews and updates. Ensure policies are accurate and in accordance with applicable regulatory requirements.
13. Demonstrate understanding of department relationships and external partnerships to support Hospital Relations’ daily operations.
14. Demonstrate a commitment to support IEHP’s efforts to become a 5-Star Health Plan and incorporate LEAN principles into daily work.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Four (4) 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). Demonstrated experience working with data systems and data sets.

Preferred Experience

Experience with electronic medical records, documentation, reporting/analysis preferred.

Education Qualifications

Bachelor’s degree in Mathematics, Statistics, Computer Science, Healthcare or related field from an accredited institution required.

Preferred Education

Master’s degree from an accredited institution preferred.  

Professional Certification

Professional Licenses

Drivers License Required

Knowledge Requirement

Signifiant knowledge of Microsoft Suite is essential. Working knowledge of medical terminology and knowledge of managed care, claims payment processes and insurance terminology preferred. Significant knowledge of concepts, practices, and procedures within a healthcare setting. Well-versed in relational database structures and database design. Demonstrate understanding of department relationships and external partnerships to support Hospital Relations’ daily operations.

Skills Requirement

Analytical skills with emphasis on healthcare services, regulatory interpretations and problem solving. Strong verbal and written communication skills.

Abilities Requirement

Strong attention to detail. Ability to research, analyze data and make sound recommendations.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

Word processing and data entry involving computer keyboard and screens.

Position is eligible for Hybrid work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

Work Model Location

Physical Requirements