Clinical Quality Data Analyst (Remote Eligible - IA/SD)

Des Moines, IA

About the position

Use your strengths as a Clinical Quality Data Analyst! In support of the Clinical Quality Program and HEDIS including accreditation, and compliance activities, you will manage core business processes related to the annual HEDIS season and quality improvement initiatives. You will be responsible for successful HEDIS submissions and assuring compliance with state and federal regulations and accreditation standards. Additionally, you will serve as a resource and subject matter expert to stakeholders and leaders within the organization for HEDIS and quality programs.

Responsibilities

• Provide coordination for the Wellmark HEDIS program and ensure adherence to audit standards and technical specifications.
• Support the annual HEDIS season including the annual HEDIS Technical Specification update project and audit-related activities.
• Train and educate contract nurses. Develop and maintain training materials and resources to ensure training documents are aligned with current technical specifications.
• Lead and manage the IRR (inter-rater reliability) testing to ensure accurate and consistent data abstraction during medical record review.
• Medical record retrieval from provider offices, health systems, and third-party copy vendors.
• Contribute to the HEDIS product team by providing subject matter expertise.
• Educate and engage Wellmark internal and external stakeholders on Wellmark’s Clinical Quality Program, accreditation, and HEDIS activities.
• Identify, recommend, and implement quality improvement initiatives that promote the delivery of appropriate identified care, coordinated to preserve member benefit dollars as well as improving member health status, and member satisfaction with Wellmark.
• Provide quantitative and qualitative analysis of HEDIS results, identify opportunities for improvement, and measure and analyze the interventions in support of NCQA accreditation.
• Develop quality improvement reports, dashboards and present to the Quality Improvement Committee and internal business partners.
• Comply with regulatory standards, accreditation standards, HEDIS Technical Specifications, and internal policies.
• Support assigned accreditation/audit functions during surveys as applicable and appropriate.
• Support Wellmark’s quality improvement work plans and provide support to the Wellmark Quality Improvement Committee.
• Provide support to the Health Services leadership team by interacting with Wellmark corporate compliance team to assess impacts from state and federal regulatory requirements and Blue Cross and Blue Shield Association mandates.
• Support the Business Continuity Planning and preparation process.
• Other duties as assigned.

Requirements

• Registered nurse with a bachelor’s degree in nursing or direct and applicable work experience.
• 2+ years of experience analyzing health care quality related data (e.g., HEDIS, ACO, quality improvement) in a health insurance, clinical operations, management care or related government setting.
• Strong attention to detail and the ability to identify, research, and analyze issues, organize information, and make appropriate decisions.
• Knowledgeable in regulatory standard or regulation review – e.g., NCQA, accreditation standards, governmental regulations, and confidentiality.
• Strong written and verbal communication skills with the ability to communicate and/or present complex information to stakeholders in a consumable manner.
• Strong consultation, relationship management, and critical thinking skills.
• Demonstrated success in roles that require strong time management and workflow management skills.
• Proficiency with Microsoft Office applications, such as Word, Excel, Outlook, PowerPoint and Teams.
• Ability to travel 5-10% as needed.

Nice-to-haves

• CPHQ (Certified Professional in Healthcare Quality).