Quality Systems Analyst II - Hospital Relations

Date: Jul 26, 2022

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 7726 

 

Position Summary/Position

 

Under the direction of the Clinical Director, Hospital Relations, the Quality Systems Analyst II – Hospital Relations (QSA 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 supports 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.  Works closely with leadership teams across the organization and at provider hospitals in support of quality improvement initiatives and studies.

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. 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.
4. 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.
5. 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.
6. 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. 
7. Assists in the development of training materials, communications, and presentations for various levels of management depending on audience and deliverables.
8. Responsible for maintaining updated knowledge of IEHP business operations for performance and quality improvement studies, action plans and programs.  
9. Maintain knowledge of current NCQA Health Plan Accreditation Standards and the ability to interpret NCQA communications and changes.  Develops knowledge base on quality measures and relevant metrics that may be utilized to develop, track, and evaluate new and existing programs. 
10. 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.
11. Lead 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.
12. Demonstrate understanding of department relationships and external partnerships to support Hospital Relations’ daily operations.
13. 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

Leading: Self

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

No

Knowledge Requirement

 

Advanced knowledge of Microsoft Suite is essential. Working knowledge of medical terminology and knowledge of managed care, claims payment processes and insurance terminology preferred. Requires general knowledge of concepts, practices, and procedures within a healthcare setting.  

Skills Requirement

 

Analytical skills with emphasis on healthcare services, regulatory interpretations and problem solving.  Ability to research, analyze data and make sound recommendations. Strong verbal and written communication skills.

Abilities Requirement

 

Demonstrate understanding of department relationships and external partnerships to support Hospital Relations’ daily operations. 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

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
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

 

Starting Salary: $91,000.00  - $116,022.40  

Pay rate will commensurate with experience

 

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