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Job Category: Clinical
Department: Quality Performance Management
Location:
Los Angeles, CA, US, 90017
Position Type: Full Time
Requisition ID: 9064
Salary Range: $117,509.00 (Min.) – $143,607.00 (Mid.) – $188,015.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County’s vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.
Job Summary
The Manager of Stars Analytics (MSA) is responsible for the operations, projects and planning for all reporting and analytics focused on Medicare Stars, QRS, and other data-sharing and/or quality improvement programs focused on enhancing member experience, quality of life, and thereby improving star ratings. The MSA is responsible for analyzing, monitoring, reporting, and providing technical collaboration and data driven decision making on clinical and operational quality improvement activities related to these programs. The MSA recommends policies, and leads process improvement efforts.
Additionally, the MSA works with the Stars Core Team, department leadership, and the provider network on developing plan-wide quality improvement and data strategy activities. The MSA assists in developing a long-term plan for analytics and evaluation activities to support the Stars strategy and goals, including enterprise wide data and analytics solutions. The MSA manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct and indirect staff reports.
Duties
Leverage data to inform targeted strategies that indicate whom to engage, with what content and through which channel and frequency: prioritize members and providers based on characteristics, such as RAF scores, open care gaps and Stars performance to enable a targeted and tailored outreach for members and providers through preferred channels – web, print, email, etc.
Implement a data-driven Stars strategy and predictive model to prioritize a set of measures that will drive higher Star rating. Measures should be evaluated on a regular schedule to accommodate Stars performance changes throughout the year. These insights will enable accountable entities to make in-flight adjustments as needed, throughout the measurement year.
Establish streamlined and accurate process for Stars performance scorecards at the contract, provider and member level along with predictive analytics models. Work closely with QPM, HIM and other analytics teams and vendors to ensure provider web based quality tools used to monitor performance and close diagnosis and care gaps are complete, accurate, timely and provide actionable insights at the member level.
Develop meaningful dashboards, reports, tools, and presentations to inform and influence Stars strategy and related activities.
Act as an analytics and technical subject matter expert on teams working on development and execution of Stars strategic initiatives.
Work closely with Stars Core Team (Stars Lead and Stars Program Manager) to manage and lead quality reporting and analytical strategies to enable accountable entities and stakeholders to drive quality ratings improvement for CAHPS, HOS, HEDIS, Medication Adherence and Plan Operations.
Manage staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
Perform other duties as assigned.
Education Required
Bachelor’s Degree in Business or Related Field
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Experience
Required:
At least 6-8 years of experience in HEDIS, quality improvement, risk adjustment analytics, research, or related work within a healthcare context.
At least 3-5 years’ experience in a supervisory/management position.
Skills
Required:
Experience working with complex data sets.
Ability to effectively collaborate and support cross functional department leadership.
Strong understanding of health care quality reporting programs, specifically Medicare Stars and HEDIS and health plan regulatory reporting requirements.
High degree of initiative and motivation.
Strong understanding of best practices in data visualization.
Strong understanding of value-based payment concepts and related engagement strategies.
Knowledge of SQL coding.
Knowledge of managed care concepts and principles and basic health plan operations.
Excellent analytical, problem solving and decision-making skills.
Ability to manage multiple tasks and projects and to delegate.
Excellent reading, oral and written communication and interpersonal skills.
Ability to work independently.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Additional Information
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.
Nearest Major Market: Los Angeles
Job Segment: Medicare, Healthcare