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Clinical Decision Analyst

Summary

Conducts studies and analyzes data to evaluate the IPA performance in quality improvement activities. Analyzes, develops and implements improvement activities to increase compliance rates as measured by nationally standardized benchmarks and definitions. Leads and participates in special projects, as directed.


Duties and Responsibilities

  • Conducts studies and analyzes data to evaluate the IPA’s performance in quality improvement, with duties including but not limited to:
    • Performing computer based statistical analysis of data related to the Quality Improvement Program
    • Completion of ICE Quarterly Reports for all lPAs
    • Monitoring and ensuring the validity of data
    • Performing analysis to determine statistically significant trends in the data compared to industry standards and recognized benchmarks
    • Providing technical expertise in statistical analysis to QM staff and external clients as necessary
    • Creating process documentation for QI/HEDIS activities
    • Collaborating with practices to integrate their EHR data into IPA reporting
  • Analyzes, develops and implements improvement activities to increase compliance rates as measured by nationally standardized benchmarks and definitions, with duties including but not limited to:
    • Identifying preventive care areas with declining or plateauing compliance rates over time, including root cause analysis for contributing factors;
    • Working with provider offices directly to increase compliance rates and practice improvement
    • Evaluating and reporting compliance rates on a quarterly basis
  • Assists the QM Senior Supervisor and Manger with HEDIS reporting, with duties including but not limited to:
    • Working with supplemental data sources such as immunization registries and lab/radiology vendors
    • Training staff in the use of lnterpreta (HEDIS Engine) and serving as a Subject Matter Expert
    • Serve as a primary contact for HEDIS staff regarding lnterpreta password setup
  • Participates in special projects, as directed
  • Performs other duties as assigned

Minimum Qualifications:

  • Three (3) years of experience in statistical analysis pertaining to quality improvement in a managed care environment; or an equivalent combination of education and experience which would provide the required knowledge and skills to qualify for this position
  • BS in Computer Science or Trade School Graduate in Technology preferred

Knowledge, Skills and Abilities Required:

  • Working knowledge of HEDIS reporting
  • Working knowledge of Medicare and STAR ratings
  • Working knowledge and understanding of SQL
  • Working knowledge of Medi-Cal managed care principles
  • Ability to apply the principles and methods of research methodology; statistical analysis and report design
  • Proficient in Microsoft Office products including Excel, Access and PowerPoint
  • Ability to plan, organize and lead data collection activities
  • Ability to prioritize tasks and deadlines
  • Ability to think and work effectively under pressure and accurately complete tasks within established times
  • Ability to communicate effectively, both orally and in writing

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