Job Description

General Summary

Under general supervision gathers and analyzes clinical and financial data that assists with driving practice transformation, quality program compliance and improved patient care. Provides clinical data extraction expertise through analysis of population health data (clinical quality measures) extracted from practice EHR, payer data and patient experience data. Assists the clinical and quality improvement teams in identifying health care trends in health outcomes, utilization, population and disease management, and patient experience. Partners with end users to identify their reporting needs and solutions. This position will assist the practice in monitoring deadlines and deliverables to assure the practice meets program deadlines as well as reporting progress to leadership and to the convening entity on value-based care programs. This role reports to a manager of Medical Economics.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

• Completes analysis, design, data testing, workflow validation and support services for assigned quality measure/payment programs.
• Serves as a liaison between population health platform, EMR and clinicians; prioritizes problems for effective and timely resolution, and develops/communicates resolution plan/approach and recommendations.
• Collects, analyzes, and acts upon claims, surveys, financial, EMR and other available data with respect to members and providers to effectively manage care, including the measurement of specific metrics and the impact of UM-QCN member and provider interventions.
• Exhibits mastery of reporting projects, data manipulation and analysis.
• Creates and maintains reports, queries, tables and downloads.
• Analyze trends and variances in detail over time and against national and local benchmarks.
• Design and implement report modifications to enhance accuracy and efficiency.
• Assist clinical care a meaning of reports.
• Facilitating process change for accurate and reportable data entry including on-going monitoring for adherence to process.
• Provides data for patient outreach efforts at the practice level (i.e. providing lists of gaps in care and patients with uncontrolled disease for patient outreach).
• Review, utilize multiple data sources (i.e. EHR eCQMs, patient experience, payer, IPA) to support population health including care coordination. Makes recommendations and provide alternatives with regards to various development and support initiatives.
• Responsible for and oversees day to day tracking and follow-up on issues and questions of daily operations. Validates testing results for quality measure programs.
• Serves as point of contact for resolution of complex workflow or measure issues; able to quickly assess problems and identify resolutions.
• Makes recommendations and provide alternatives with regards to various measure workflows, education, reporting and support initiatives.
• Prepares written documentation of various types; process documentation, analytical reports, functional specifications, training manuals, status reports, etc. Creates, evaluates and instructs/teaches other analysts.
• Support UM-QCN analytical activities as needed related to UM-QCN work on value-based care programs.
• Conduct data analysis on impact of legislative and regulatory proposals (quality measure standards and program requirements) and analyze trends affecting UMMS affiliates, UMQCN and providers.
• Prepares written documentation of various types; system/workflow documentation, analytical reports, functional or workflow specifications, training manuals, status reports, etc.
• Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

Qualifications

Education and Experience

• Bachelor's Degree in a health, science, or business field, or an equivalent level of professional experience required. Masters degree preferred.
• Two years progressively responsible experience in quality management, population health or outcomes management, is required.
• General knowledge of Quality Reporting programs (PQRS, MU, VBM, MIPS) is preferred. Understands quality improvement concepts and tools.
• Experienced in EHR data extraction, analysis and presentation to Primary Care Leadership and Staff is preferred
• Experienced in data manipulation using a variety of tools such as excel, Tableau, Power BI etc. is required.

Knowledge, Skills and Abilities

• Maintain a core understanding of population management, identifying patients that would benefit from population health services (patient outreach, appointments, care coordination) by using a variety of data sources Knowledge of practice transformation and the CMS Quality Payment Program, health care quality improvement concepts
• Knowledge of population health, triple aim, and medical home concepts and has the understanding of how they are shaped by the health system and communities.
• Knowledge of national quality organizations, including National Committee of Quality Assurance (NCQA) structure and standards and Health Plan Employer Data and Information Set (HEDIS) and National Quality Forum (NQF).
• Ability to perform and teach analysis and problem solving principles with emphasis in quality and outcomes data gathering techniques, and management information applications to staff is required. Serves as a resource to others in the resolution of complex problems and issues.
• Skills in developing and implementing process improvements activities that are focused on improving triple aim goals of quality, cost, and satisfaction.
• Demonstrates ability to develop complex solutions that address quality measure compliance. Solutions may include technology updates or workflow changes.
• Problem-solving skills with the ability to identify improvement opportunities and recommend solutions to problems
• Intermediate MS Office Skills
• Makes recommendations regarding the workflow that supports improved compliance.
• Effective customer service skills, with the ability to work with all levels within the organization.
• Effective verbal and written communication skills are necessary to advise and consult with clinical and business owners, make formal presentations of project findings and recommendations.
• Excellent organization skills; demonstrates confidence and creativity.

Additional Information

All your information will be kept confidential according to EEO guidelines.

Compensation:

Pay Range: $35.08 - $41.55

Other Compensation (if applicable):

Review the 2024-2025 UMMS Benefits Guide