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Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Responsible for supporting the execution of the assigned quality program strategy through data analysis to drive results to improve or maintain quality performance, outcomes and / or rating. This position will be responsible for the development of reports, enhancements to existing reports, data analysis, and business processes which will inform and enable leader(s) to make informed decisions based on data. This position involves collaborating with cross-functional teams, ensuring the accuracy and completeness of Quality data, to optimize processes to enhance performance, maximize revenue and ensure compliance.

Essential Responsibilities :

• Collect, analyze, and interpret quality performance and results using statistical techniques.
• Generate regular reports on performance metrics, trends, and areas for improvement.
• Develop and maintain dashboards to track key performance indicators (KPI).
• Execute quantitative analyses that translate data into actionable insights.
• Review reports and performance indicators to improve quality ratings.
• Provide analytical and data-driven, decision-making support for key projects.
• Identify opportunities for improvement in quality ratings and measures.
• Collaborate with cross-functional teams to develop and implement action plans.
• Monitor the effectiveness of interventions and adjust strategies as needed.
• Communicate findings on a regular basis to all levels of business and management.
• Stay apprised of changes made by regulatory and governing bodes to relevant program guidelines, methodology, and regulations.
• Interpret policy changes and model impacts to plan performance and operations.
• Work closely with internal departments, including clinical, operations, and customer service teams, to align quality improvement efforts.
• Communicate findings and recommendations to senior management and other stakeholders.
• Provide training and support to staff on quality program requirements and best practices.
• Support strategist to improve member and provider engagement, increase compliance, and drive gap closures.
• Share insights with stakeholders to support the production of educational materials and campaigns.
• Stay current with industry trends, best practices, and regulatory changes related to the applicable quality ratings program.

Supporting Responsibilities :

SUCCESS PROFILE

Work Experience : Minimum of 3 years of experience in data analysis or a related field required. Experience with health plan quality improvement, specifically quality metrics, or other healthcare quality related experience preferred.

Education, Certificates, Licenses : Bachelor's degree in healthcare administration, business administration, mathematics, computer science, information systems, or related field, or equivalent years of additional relevant experience in lieu of degree is required. Master's degree is preferred.

Knowledge : Proven proficiency in data analysis tools and software (e.g., Excel, SAS, SQL) and data visualization / analytics tools (Tableau, Power BI) required. Knowledge of CMS Stars rating and OHA Quality Incentive measures including HEDIS, CAHPS, PQA / Pharmacy, HOS, and Display measures. Demonstrated skills in quality improvement concepts, healthcare data analysis, data mining methods and the identification of population health issues, trends, and health disparities using healthcare data sources. Demonstrated ability to analyze complex data sets, identify patterns, and drive actionable insights. Familiarity with statistical analysis and machine learning techniques is a plus. Exceptional problem-solving and critical-thinking abilities, with strong attention to detail. Ability to identify and resolve technical issues in a timely manner. Must have strong business acumen to interpret strategic vision into an operational model. Ability to work independently with minimal supervision.

Competencies

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment : Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Skills :

Accountability, Collaboration, Communication (written / verbal), Flexibility, Listening (active), Organizational skills / Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :

Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.