Medicare Stars Analyst

About the position As a core member of the Government Programs Star Performance team, the Medicare Stars Analyst provides ongoing analytic support to the development and execution of the health plan’s best in class 5-star strategy. In collaboration with the VP, Medicare Stars, this person will work with key stakeholders from across the company, e.g. performance measurement and improvement, clinical quality, operations, and pharmacy, to identify opportunities for improvement and measures of success in the pursuit of continuous quality improvement of our Medicare stars ratings. The successful candidate will have an established track record of identifying and executing data driven solutions across a myriad of projects, including but not limited to, clinical quality, member satisfaction, and operational excellence.

Responsibilities

• Works with Stars Performance leadership and stakeholders from across the organization to analyze root causes driving poor Star performance and propose data driven solutions that facilitate improvement.
• Provide subject matter expertise of the CMS Star Rating methodology, and act as a resource when methodological questions arise.
• Develops targeted recommendations to inform effective member and provider outreach strategies to improve health care outcomes and consumer experience among Medicare population.
• Generates and tests working hypotheses: aggregate and mine data, conduct analyses, and extract actionable results.
• Develop analytic dashboards to track performance of access to care, clinical quality and consumer experience metrics and to predict the performance trending in Medicare population.
• Partners with technical teams to design and improve Medicare data intake and storage infrastructure to enable efficient analytics.
• Prepares and presents analysis results to internal decision-makers, often creating informative business metrics to influence decision makers.

Requirements

• A deep understanding of the CMS Star rating methodology with experience working across all measurement domains including clinical performance, member experience, and operations.
• Experience mapping business needs to analytics planning and technical requirements.
• Experience in working with large structured and unstructured data sets.
• Demonstrable knowledge of, and practical experience in applying advanced analytics, and methodologies to support business decision making.
• Ability to independently execute projects with multiple business stakeholders on firm deadlines.
• Ability to identify opportunities to enhance productivity, increase efficiency, simplicity, and add measurable tangible and intangible values.
• Strong teamwork and ability to solve data and analytics problems through communication and collaboration.
• Data analytics experience a must; strong technical skills in programming with SAS, R, Python or other tools.
• Excellent written and verbal communication skills, with the ability to clearly and concisely present issues, analytical planning, and recommendations in verbal, written and presentation formats across all levels of the organization.
• Five (5) or more years of healthcare experience, with at least 2 years working on Center for Medicare and Medicaid (CMS) Stars programs, National Committee for Quality Assurance (NCQA) programs, and Healthcare Effectiveness and Data Information Set (HEDIS) management and analysis.
• Understanding of Stars measures, financial impact and interpretation of results, weighting and cut points to enable Stars measure improvements.
• Strong teamwork and ability to solve data and analytics problems through communication and collaboration.
• Bachelor’s degree in statistics, applied math, or related field is required.

Nice-to-haves

• Advanced degree (MA/MS or PhD) is a plus.
• Experience in applying advanced analytics to improve population health, care management, and consumer experience.

Benefits

• We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

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