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Corporate Functions & Operations WellCare - Quality Improvement Careers

Quality Improvement Analytics Manager Job

Full Job Title: Mgr, QI Analytics

Job Number: 1804457

Location: Atlanta, GA

Date Posted: 6-18-2018

Responsible for overseeing the quality improvement reporting (HEDIS) and related projects. With the direction from Sr. Leadership, oversees, designs, and manages operation and coordination of all aspects of Medicare and Medicaid Quality Improvement reporting and analysis functions for the assigned market(s). Establishes analytical methodology for QI-processes and performance-based initiatives, including validation processes and the delivery of healthcare informatics services to all WellCare internal and external entities and agencies.

Reports To: Senior Director, Quality Improvement

Department: Quality Improvement

Position Location: Atlanta, GA.

Essential Functions:

  • Defines and develops analytical methodologies and procedures to provide quantitative solutions for QI initiatives, their implementations and delivery of automated solutions, by querying, collecting, analyzing, summarizing information & trends, and by providing consultancy to healthcare associates, analysts and programmers.
  • Works with team of analysts to provide quantitative analysis on various quality measures and health education by planning, collecting and analyzing proper sources of data, and by writing SAS and SQL codes to extract and analyze appropriate data sets.
  • Participates in project planning activities, and develop project plans for tasks, time line, and milestones to ensure projects are delivered timely. Update management regarding project statuses, risks and resolution options.
  • Presents findings on any trends and assists business leaders with forecasting in support of evidence based decision making.
  • Responsible for performing and developing Quality Improvement measures (HEDIS type measures), performing intervention analysis, preparatory documents required for auditors, oversight agencies, and by using WellCare's database and member/provider information.
  • Effectively manages internal and external vendor communications by collaborating and disseminating reports and defining program descriptions, and by sharing analytical findings with designated internal and external parties, and government regulators.
  • Ensures compliance with regulatory requirements in collaboration with the compliance department.
  • Review data to determine operational impacts and needed actions; elevate issues, trends, areas for improvement and opportunities to management.
  • Provides guidance and training to new associates and overall leadership to the team.
  • Performs other duties as assigned.
Additional Responsibilities:Candidate Education:
  • Required A Bachelor's Degree in HealthCare, Nursing, Public Health, Health Administration or directly related field
  • Required or equivalent work experience
  • Preferred A Master's Degree in a related field
Candidate Experience:
  • Required 5 years of experience in health care industry
  • Required 2 years experience in leading/supervising others
  • Required Other Previous QI analytics experience
  • Preferred Other Experience working within a clinical setting
Candidate Skills:
  • Advanced Demonstrated written communication skills
  • Advanced Demonstrated problem solving skills
  • Advanced Demonstrated analytical skills
  • Advanced Demonstrated problem solving skills
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Ability to multi-task
  • Advanced Ability to effectively present information and respond to questions from families, members, and providers
  • Advanced Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
  • Intermediate Ability to lead/manage others
  • Advanced Demonstrated project management skills
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Advanced Microsoft Excel
  • Required Advanced Microsoft Word
  • Required Advanced Microsoft Visio
  • Required Advanced Microsoft PowerPoint
  • Required Advanced Microsoft Outlook
  • Required Advanced Other SAS and SQL

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Last Updated On: 12/9/2015