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Looking for a highly motivated individual that is excited to make a difference and has a mind set for process improvement! As a Clinical Quality Analyst you will be instrumental in ongoing process improvement projects, be responsible for data measures and deliverable to Medicaid. The right candidate will be passionate about serving our patients and providers and working to break down barriers that interfere with quality healthcare. Experience in AHCCCS/Medicaid is a plus!
This can be a remote position if you live in the following states only: AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MI, MS, MN, MO, NY, ND, NE, NV, OR, PA, SC, TN, TX, UT, VA, WI, WA, & WY
Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
This position, under the direction of the Director of Quality Management and the Manager of Performance Improvement, is responsible for supporting the health plan???s member and provider initiatives by generating reports.
CORE FUNCTIONS 1. Supports the development, implementation, and evaluation of performance improvement projects. Manages reports and databases used for member and provider intervention activities aimed to improve upon the AHCCCS performance standards and CMS HEDIS measures.
2. Develops, coordinates, provides operational management, and monitors Performance Improvement Projects (PIP???s) according to AHCCCS guidelines and requirements. Collaborates with the health plan???s IS Department to implement valid data sources, research tools, and other data collection instruments. Actively participates in the design, implementation, application and utilization of Performance Improvement information systems in assigned focus areas. Facilitates the accuracy and completeness of clinical information used for measuring and reporting physicians performance improvement outcomes. Develops new and evaluate existing interventions through workgroups. Facilitate material development, printing, mail services and automated telephone calls through contracted vendors in compliance with current marketing guidelines and policies.
3. Develops, compiles, reviews, validates, prepares, and submits clinical and administrative reports required by State and National agencies. These reports may include but are not limited to: Assigned quarterly departmental reports to Quality Management / Performance Improvement Committees, EPSDT Adult Performance Quarterly Reports, annual Performance Improvement Project (PIP) reports, and Corrective Action Plans (CAP). Maintains status updates on assigned reports to facilitate ongoing evaluation and identification of opportunities for improvement
4. Creates and manage datasets for Quality and Medical Management Systems and other department studies as assigned, including but not limited to setting up database and associated data entry programs, and retrieving data from the database for purposes of analysis or data review.
5. Requests, compiles, sorts, prepares, reviews, validates, and analyzes data extracted from Oracle Reports, ManagedCare.com, TCS, medical records and survey tools using statistically reliable sampling methods.
6. Utilizes IDX and / or other medical management system to validate data for initial projects and an annual review of ongoing projects ensuring the proper use of CPT, ICD-9, HCPCS, and UB Revenue codes. Conducts data analysis using Excel or SPSS software
7. Serves as a front line liaison with physicians, staff, members, contracted vendors and the public concerning requests for information regarding UAHP and the Performance Improvement QM Department.
8. Works independently with minimal supervision.
Knowledge, skills and abilities as normally obtained through the completion of a bachelor's degree and three to five years of reporting experience. Must be knowledgeable of the National Committee for Quality Assurance (NCQA), Health Plan Employer Data Information Set (HEDIS), Arizona Health Cost Containment System (AHCCCS) and Centers for Medicare and Medicaid Services (CMS) standards and reporting requirements.
Strong analytical skills, demonstrated knowledge of and experience with / use of multiple computer programs including word processing, data management and computer graphics. Demonstrated ability to interface with business and medical professionals. Must have superior verbal and written communication skills. Ability to maintain strict confidentiality along with good problem solving and investigative skills is required. Ability to set appropriate priorities relative to work load in a fast paced environment; to develop standards and implement data sources, research tools, and other data collection instruments; to collect, analyze, describe, evaluate data, and write reports; to implement and track the effectiveness of process improvement; to recognize risk management concerns; and to review and extract significant data from medical records is required.
Demonstrable experience with using analytic tools, such as Microsoft EXCEL and ACCCESS required. The ability to travel to all contracted sites, which may necessitate occasional overnight stays.
Advanced computer skills preferred.
Additional related education and/or experience preferred.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health.
Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible.
The size, success and growth of our system provide you with the stability and options to pursue your desired career path.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.