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Director, Clinical Quality Analytics

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POST DATE 10/10/2017
END DATE 3/7/2018

Blue Shield of CA Costa Mesa, CA

Costa Mesa, CA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
17002IO-Costa Mesa
Mid-Career (2 - 15 years)
Bachelors Degree


Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of Californias Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

The Director, Clinical Quality Analytics is responsible for HEDIS production and for providing data and analytic support for clinical quality programs. This position reports to the VP Enterprise Analytics and dotted line to the VP Clinical Quality within the Healthcare Quality and Affordability organization (HCQA).

This position interfaces and partners with the Quality Management and Medicare Star Leadership teams and cross functional business partners to provide data and analytical support for clinical quality projects, including opportunity identification, performance and analytical reporting, program design, impact analysis, and program evaluation. The success of this leadership role results in improve quality ratings, health plan accreditation status, enhance revenue, and reduce administrative and costs of healthcare delivery.

The Director, Quality Analytics manages a team of professional employees with extensive knowledge in clinical quality measurement methodology, HEDIS production, medical record review, NCQA Accreditation, Medicare Star reporting, and regulatory reporting requirements. The position is based in one of our main CA offices (San Francisco or Woodland Hills).


* Oversee all aspects of HEDIS production, including data extraction, processing, medical record review, survey, audit, and report submission to NCQA.

* Oversee care gap reporting for member and provider intervention programs.

* Deliver contractual quality reporting to provider partners timely to improve quality ratings and for Pay for Performance programs.

* Identify, in collaboration with Clinical Quality teams, a set of quality of care metrics to be produced regularly.

* Develop and deliver these metrics on pre-determined schedule.

* Analyze HEDIS data, Medicare STAR rating data, and other quality of care data to identify improvement opportunities.

* Provide consultation to Clinical Quality teams for quality improvement programs design and development.

* Support implementation of clinical quality projects, including estimating size of the population, potential impact, monitoring progress, reporting and evaluation.

* Provide, in collaboration with Clinical Quality teams, requirements for clinical quality data infrastructure to support clinical quality measurement and reporting activities.

* Monitor vendor-managed programs to ensure compliance with service level agreements and quality outcomes.

* Manage team: hiring and training, performance and salary reviews, promotions and disciplinary matters for direct reporting employees.

* Bachelors degree in health care administration, health services research, public health, epidemiology, economics, statistics, computer science or a relevant field. Masters preferred.

* Minimum three years of experience in leading HEDIS production and clinical quality measurement

* Minimum three years of experience in analyzing health care insurance claims data or electronic medical record data

* Minimum five years of hands-on experience in data analysis tools, including but not limited to SAS, SQL, SPSS, Access, Cognos, Tableau.

* Minimum three years of supervisory experience leading an analytics/ research team

* Preferred: 3 years of experience in program evaluation methodology, and statistical analysis.