Hospital Systems Analyst III - Hospital Relations

Date: Sep 22, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7895 

 

Position Summary/Position

 

Under the direction of the Clinical Director, Hospital Relations, the Hospital Systems Analyst III - Hospital Relations (HSA III - Hospital Relations) leads departmental efforts to utilize clinical analytics to make health/quality management recommendations, as well as implement quality improvement activities based on those analytics that revolutionizes IEHP compliance standards, strategic goals, and initiatives. Key activities include engaging with stakeholders to develop and execute technical analyses, evaluate existing data sources, create visualization tools, and recommend strategic business unit decisions and action plans. Lead projects that support key deliverables including study development, data collection, data analysis, policy interpretation, policy creation and updates. Act as main liaison with leadership teams across the organization and at provider hospitals and ancillary services in support of operations, quality improvement initiatives and studies. In addition to advanced analytical skills, the Hospital Systems Analyst III - Hospital Relations will display 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.

Major Functions (Duties and Responsibilities)

 

1. Serve as technical lead for the development, preparation and presentation of detailed, complex reports and analyses to support IEHP’s Hospital Relations quality improvement programs utilizing available analytical tools and quality improvement methods. Develop new and alternative analytical tools to support current and emerging business unit requirements.
2. In support of quality standards, strategic goals, and initiatives for 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.  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. 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.
5. 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 Hospital Relations leadership team if any project deadlines or other deliverables are at risk.
6. Ensure the department’s continuous evaluation of trends related to quality measures, clinical and operational program performance. Leads assigned performance improvement efforts.
7. Lead 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. Provide recommendations for 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. Act as Subject Matter Expert of regulatory requirements, including 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.

Major Functions (Duties and Responsibilities) Cont

 

11. 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.
12. Lead 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.

Supervisory Responsibilities

Leading: Guides Others

Experience Qualifications

 

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). Demonstrated experience working with complex data systems and data sets. Experience with electronic medical records, documentation, reporting/analysis required.

Preferred Experience

Education Qualifications

 

Master’s degree in Mathematics, Statistics, Computer Science, Information Systems, Business Administration, Healthcare or related field from an accredited institution required.

Preferred Education

Professional Certification

Professional Licenses

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Advanced understanding of statistical methods, data analysis, and study methodology. Advanced knowledge of Microsoft Suite is essential. Working knowledge of medical terminology and knowledge of managed care, claims payment processes and insurance terminology required. Advanced knowledge of concepts, practices, and procedures within a healthcare setting preferred. 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

 

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.

Abilities Requirement

 

Strong attention to detail.

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.

Work Model Location

Hybrid

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Sitting - CONSTANTLY
Lighting - CONSTANTLY
Indoors - FREQUENTLY
Memory - FREQUENTLY
Regular and reliable attendance - CONSTANTLY
Hearing: In a group - FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY
Communicate: Give instructions, advise, warn, instruct - FREQUENTLY
Perform complex and varied tasks - CONSTANTLY
Develop and maintain positive work relationships - CONSTANTLY
Adaptability: rate of change in work location - FREQUENTLY
Lead/Influence Others - FREQUENTLY
Rapid Pace of work - CONSTANTLY
Control of work pace - CONSTANTLY
Pace of work with faster/slower work periods - FREQUENTLY
Problem Solving - FREQUENTLY
Understand and follow direction - CONSTANTLY

A reasonable salary expectation is between $103,708.80  - $132,225.60, based upon experience and internal equity.

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 7,000 and a team of more than 2,500 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles