Manager, Clinical Quality Analytics (STARS, SQL)

Salary Range:  $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Manager of Stars Analytics (MSA) is responsible for the operations, projects and planning for all reporting and analytics focused on Medicare Stars, QRS, and other data-sharing and/or quality improvement programs focused on enhancing member experience, quality of life, and thereby improving star ratings. The MSA is responsible for analyzing, monitoring, reporting, and providing technical collaboration and data driven decision making on clinical and operational quality improvement activities related to these programs. The MSA recommends policies, and leads process improvement efforts.

Additionally, the MSA works with the Stars Core Team, department leadership, and the provider network on developing plan-wide quality improvement and data strategy activities. The MSA assists in developing a long-term plan for analytics and evaluation activities to support the Stars strategy and goals, including enterprise wide data and analytics solutions. The MSA manages all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct and indirect staff reports.

Duties

Leverage data to inform targeted strategies that indicate whom to engage, with what content and through which channel and frequency: prioritize members and providers based on characteristics, such as RAF scores, open care gaps and Stars performance to enable a targeted and tailored outreach for members and providers through preferred channels - web, print, email, etc.

Implement a data-driven Stars strategy and predictive model to prioritize a set of measures that will drive higher Star rating.  Measures should be evaluated on a regular schedule to accommodate Stars performance changes throughout the year. These insights will enable accountable entities to make in-flight adjustments as needed, throughout the measurement year.

Establish streamlined and accurate process for Stars performance scorecards at the contract, provider and member level along with predictive analytics models. Work closely with QPM, HIM and other analytics teams and vendors to ensure provider web based quality tools used to monitor performance and close diagnosis and care gaps are complete, accurate, timely and provide actionable insights at the member level.

Develop meaningful dashboards, reports, tools, and presentations to inform and influence Stars strategy and related activities.

Act as an analytics and technical subject matter expert on teams working on development and execution of Stars strategic initiatives.

Work closely with Stars Core Team (Stars Lead and Stars Program Manager) to manage and lead quality reporting and analytical strategies to enable accountable entities and stakeholders to drive quality ratings improvement for CAHPS, HOS, HEDIS, Medication Adherence and Plan Operations. 

Manage staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

Perform other duties as assigned.

Duties Continued

Education Required

Bachelor's Degree in Business or Related FieldIn lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Experience

Required:

At least 6 years of experience in HEDIS, quality improvement, risk adjustment analytics, research, or related work within a healthcare context.

At least 4 years leading staff or supervisory/management experience.

Experience working with complex data sets.

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Skills

Required:

Ability to effectively collaborate and support cross functional department leadership.

Strong understanding of health care quality reporting programs, specifically Medicare Stars and HEDIS and health plan regulatory reporting requirements.

High degree of initiative and motivation.

Strong understanding of best practices in data visualization.

Strong understanding of value-based payment concepts and related engagement strategies.

Knowledge of SQL coding.

Knowledge of managed care concepts and principles and basic health plan operations.

Excellent analytical, problem solving and decision-making skills.

Ability to manage multiple tasks and projects and to delegate.

Excellent reading, oral and written communication and interpersonal skills.

Ability to work independently.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.  The range is subject to change.

L.A. Care offers a wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)