Manager, National Quality Analytics & Reporting – Medicare Stars

Job Summary

Leads and manages team responsible for Molina enterprise quality reporting activities for quality improvement initiatives. Oversees design and development of reporting solutions to support Star Rating and Healthcare Effectiveness Data and Information Set (HEDIS) auditing, rate tracking, identification of targeted interventions, and performance metric outcome tracking, and the collection, validation, analyzation, and organization of data into meaningful reports for operational/strategic analysis and decision-making.

Essential Job Duties

• Manages quality data and predictive intervention analytics strategies, and corresponding progress tracking and impact of programs/interventions.

• Manages design and development of ad-hoc and automated analytics and reporting modules related to Star Rating and quality/HEDIS for Marketplace and Medicare Plan lines of business.

• Perform ROA analysis.

• Collaborates cross-functionally to capture and document requirements, manages report development efforts, and educates users on how to use reports.

• Manages the design and leads development of retrospective Star Rating and HEDIS rate tracking, supplemental data impact reporting and intervention’s strategy reporting.

• Manages development of medical record review project reporting to track progress and team productivity reporting.

• Develops analysis and reporting related to managed care data including claims, pharmacy, lab and Star Rating and HEDIS rates.

• Conducts root-cause analysis for business data issues, reports to leadership the summary of findings and resolutions.

•Provides oversight for team members who work in an agile business environment to derive meaningful information out of complex as well as large organizational datasets through data analysis, data mining, verification, scrubbing, and root-cause analysis.

• Supports quality department with Star Rating and HEDIS measure deep dive to support Star Rating and HEDIS audit and revenue at risk reporting.

• Works in an agile business environment to derive meaningful information out of complex as well as large organizational data sets through data analysis, data mining, verification, scrubbing, and root cause analysis.

• Analyzes data sets and trends for anomalies, outliers, trend changes and opportunities, using statistical tools and techniques to determine significance and relevance. Utilizes extrapolation, interpolation, and other statistical methodologies to predict future trends in cost, utilization, and performance.

• Acts as a subject matter expert in Star Rating and HEDIS reporting and provides trainings as needed.

• Stays current with National Committee for Quality Assurance (NCQA) standards and educates team/health plans as health plan as needed.

• Assists with research, development and completion of special projects as requested by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations.

• Manages changes in the data warehouse platform and performs transparent upgrades to analytic reporting modules to ensure no impact to the end-users.

• Conducts preliminary and post-impact analyses for any logic and source code changes for data analytics and reporting modules keeping other variables as constant that are not of focus.

• Develops training modules to help analysts understand processes, solutions or designs to meet the customer request for new/existing staff.

• Provides technical, functional, and business trainings to internal and external team members to enable them to perform the required tasks.

• Assists health plans building reporting solutions to perform successful member and provider interventions.

• Maintains a team culture to adopt a fast-paced agile environment and fosters a positive attitude to take on challenging and time sensitive projects.

• Takes accountability of tasks and projects; ensures direct reports are meeting requirements as assigned, and maintains team productivity standards.

• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of quality/department-specific goals.

Required Qualifications

• At least 7 years of experience writing complex SQL queries, functions, procedures, and data design, including experience working with relational databases, Microsoft Transact-SQL (T-SQL), SQL Server Integration Services (SSIS), SQL Server Reporting Services (SSRS), and Power BI, and at least 5 years of predictive modeling experience in health care quality and HEDIS rate tracking, medical record review tracking, interventions tracking, and statistical analysis/HEDIS forecasting experience supporting quality, finance, and health plan functions, or equivalent combination of relevant education and experience.

• At least 1 year of management/leadership experience.

• Analytical mindset, excellent attention to detail, and problem-solving skills.

• Experience in working with complex data to include quantifying, measuring, and analyzing financial/performance management and utilization metrics.

• Experience working with Microsoft T-SQL, Databricks SQL and Power BI.

• Experience writing complex SQL queries, functions, procedures and data design.

• Familiarity with data science techniques and languages like Python and R programming.

• Ability to manage multiple priorities in a fast-paced, deadline-driven environment.

• Strong business acumen with the ability to connect data insights to strategic goals.

• Ability to communicate complex analytical results clearly to non-technical audiences.

• Proven ability to lead cross-functional projects and deliver value added results in a matrixed environment.

• Self-starter with a continuous improvement mindset.

• Strong verbal and written communication skills.

• Microsoft Office suite proficiency.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $79,607.91 - $172,483.8 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.