What are the responsibilities and job description for the Medical Informatics Analyst, Consultant position at Blue Shield of California?
Job Details
Your Role
The Medi-Cal Analytics team supports the Medi-Cal Business Unit . The Medical Informatics Analyst - Consultant will report to the Senior Manager, Medical Informatics and will have a dotted reported line to the Special Populations Unit, that is part of the Office of the Chief Medical Officer. In this role, you will support operational, compliance & regulatory reporting, mandated projects, and clinical key indicators, partnering closely with a large set of clinical and non-clinical teams focused on Utilization Management, Enrollment, Population Health Management, Claims Network and other areas. The Special Populations Unit (SPU) ensures effective oversight and monitoring of vulnerable groups identified by CalAIM, advancing equitable access to care and improving health outcomes. Through cross-functional collaboration and data-driven strategies, we advocate for inclusive, person-centered solutions that promote the well-being of those we serve.
Your Work
In this role, you will:
Your Knowledge and Experience
The Medi-Cal Analytics team supports the Medi-Cal Business Unit . The Medical Informatics Analyst - Consultant will report to the Senior Manager, Medical Informatics and will have a dotted reported line to the Special Populations Unit, that is part of the Office of the Chief Medical Officer. In this role, you will support operational, compliance & regulatory reporting, mandated projects, and clinical key indicators, partnering closely with a large set of clinical and non-clinical teams focused on Utilization Management, Enrollment, Population Health Management, Claims Network and other areas. The Special Populations Unit (SPU) ensures effective oversight and monitoring of vulnerable groups identified by CalAIM, advancing equitable access to care and improving health outcomes. Through cross-functional collaboration and data-driven strategies, we advocate for inclusive, person-centered solutions that promote the well-being of those we serve.
Your Work
In this role, you will:
- Conduct independent analysis of high complexity under minimal supervision and
- guidance
- Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
- Produce analysis of high complexity under the guidance and direction of Medical
- Informatics Analyst V, supervisor, or manager
- Develop documentation and create and execute workplans for analyses of high
- complexity. Workplans may coordinate the activities of Medical Informatics Analysts at lower levels and may involve collaboration with more than one team
- Provide training and mentoring for team members on best practices for analysis and reporting; assist in the development of supplemental analytic training tools and materials; conducts formal training sessions for lower-level analysts and analysts in other Departments
- Assist in identifying systems and operational problems and recommend solutions and changes to streamline procedures for more effective reporting
- Support design, implementation and maintenance of data logic and processes to support Medi-Cal data integration into health data technology platform
- Responsible to create system QA processes and documentation
- Prepare complex reports and studies for a variety of uses including cost of health care analysis, quality improvement, enhancing operations and addressing identified issues
- Utilize programming software to efficiently develop process or tools to analyze relevant data from various sources (e.g., claims, membership, provider, financial, operation and other ancillary data sources), interpret and present analytic results for all ad hoc and ongoing reporting requests
Your Knowledge and Experience
- Requires an MPH, MBA, MS, MA in Computer Science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
- Must be able to develop and modify SQL and SAS scripts and be able to wrangle large datasets, join multiple datasets. Strong working experience in SAS.
- Requires at least 7 years of prior relevant experience with at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
- Ability to work with all clinical coding systems strongly preferred
- Insight of Managed Care, Medi-Cal/Medicaid and coordination of Care.
- Prepares complex reports and studies for a variety of use cases, including cost of health care analysis, quality improvement, enhancing operations and addressing identified issues.
- Practical knowledge of agile and project management skills
- Excellent verbal and written communication and presentation skills
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