Medicaid Quality Analyst (Hybrid)

$63,576 - $126,269/Yr

CareFirst of Maryland - Baltimore, MD

Full-time - Mid Level

Baltimore, MD

Ambulatory Health Care Services

About the position

The Medicaid Quality Analyst at CareFirst BlueCross BlueShield plays a crucial role in enhancing population health through the analysis and evaluation of healthcare quality metrics. This position is responsible for defining, measuring, and operationalizing innovative initiatives aimed at improving HEDIS measure performance and the overall quality of care and experience for members. The analyst will act as the subject matter expert in population health, measurement science, accreditation, and quality improvement, utilizing the framework of NCQA Accreditation to document and accomplish work products. In this role, the analyst will define and document the performance of the health plan in facilitating quality healthcare, ensuring positive outcomes, and providing an excellent experience for members. The position requires the analysis and evaluation of health plan performance using both qualitative and quantitative methodologies, producing actionable reports and visualizations that address opportunities for improving population health quality. The analyst will prioritize, develop, and operationalize these opportunities in collaboration with other organizational areas, transforming them into innovative programs and initiatives that lead to industry-leading outcomes at a population level.

Responsibilities

• Act as the organization's subject matter expert in population health, measurement science, accreditation, and quality improvement.
• Utilize the framework of NCQA Accreditation to accomplish and document work products.
• Define, measure, and document the performance of the health plan in facilitating quality healthcare and positive outcomes.
• Analyze and evaluate health plan performance using qualitative and quantitative methodologies, producing actionable reports and visualizations.
• Prioritize, develop, and operationalize opportunities for improving population health quality in collaboration with other areas of the organization.

Requirements

• Bachelor's Degree in Population Health, Public Health, Healthcare Administration, Business Administration, Health Policy, Economics, Statistics, Mathematics, Data Science, or a related field.
• In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
• 3 years professional experience in a business environment, preferably in public health, health insurance, or management consulting fields.
• Evidence of progressing levels of responsibility in previous roles.
• RN-BC - Certified General Nursing Practice preferred.

Nice-to-haves

• Certification in Quality or Process Improvement Methods.
• Direct experience with accreditation, HEDIS, CAHPS, and other quality-related activities in a healthcare environment or payor organization.
• Data analytics experience working with large data sets to answer clinical, operational, or business questions.
• Prior experience with healthcare data is expected.
• Medicaid experience.

Benefits

• 401(k)
• 401(k) matching