What are the responsibilities and job description for the QUALITY IMPROVEMENT DATA ANALYST-LEAD position at State of Tennessee?
Executive Service
Quality Improvement Data Analyst-Lead
Division of TennCare
Chief Medical Office
Nashville, TN
Salary : TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.
Closing Date : 02 / 10 / 2025
The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.
This position requires a background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.
Who we are and what we do :
TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS).
TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency
Job Overview :
Operationally, the Quality Improvement (QI) Division works closely with several other TennCare divisions to lead the development and execution of a comprehensive quality strategy. Additionally, the QI team plays a strategic role in TennCare initiatives focused on improving clinical care and outcomes for TennCare members, including primary care transformation and population health. The QI Data Analytics (DA) team collaborates with other teams within the Chief Medical Office (CMO), including Dental, Pharmacy, Behavioral Health, and Appeals teams to provide analytics and dashboarding expertise. Externally, the QI division works closely with TennCare's contracted organizations and other state agencies to provide oversight of quality performance and data reporting for TennCare Members. This position will be a key member on the QI Data Analytics team reporting to the QI Data Analytics Director.
Key Responsibilities :
- Provide analytics / data expertise for CMO teams and for TennCare Value Based Payment (VBP) programs
- Utilize knowledge of claims data to identify key trends / insights to inform CMO leadership decisions on key clinical areas / outcomes
- Develop strategies / methodologies for completing complex data requests -Assist in the creation of new VBPs, participate in meetings, and provide data / quality measure expertise
- Create technical specifications for measures
- Code / calculate quality metrics using claims data and provide analysis comparisons as requested
- Evaluate quality measures at the individual provider or aggregate level using relevant information, individual judgement, and measure specifications
- Run annual CMS Core Measures, including stratifications by MCO and Region -Research external data sources, including Medicare data, to be included in CMS Core Measures for Mandatory reporting
- Query, collect, prepare, and safeguard data, and produce key deliverables to satisfy CMS, legislative, and other ad-hoc requests
- Support high priority legislative reporting at request of CMO and TennCare leadership
- Provide analytics expertise to review and summarize complex reports
- Perform quality checks of data and reports provided by MCOs and collaborate with the MCOs, as needed, for timely report completion
- Develop advanced analytic approaches using multiple complex databases to develop comprehensive health outcome measurements stratified by providers, hospitals, MCOs
- Partner with clinical data leads to support development of TennCare quality strategy
- Participate in the design / development of the QI dashboards
- Partner with other CMO teams to explore and utilize data specific to each team
- Provide technical assistance / training to new analysts including providing claims data knowledge, answering technical questions, and reviewing projects to provide feedback on ways to make things more efficient
- Design / develop dashboards for CMO teams to highlight projects and initiatives
- Meet with teams to understand the ask and to present the final dashboard
- Develop methodology for pulling and / or aggregating data
- Design dashboards to meet the expectations of the CMO team and DA design standards
- Assist on Data Ecosystem related items including providing expertise in meetings with the DE contractor
- Ensure methodology and data sources are correct
- Develop expert level knowledge of the data sources and how they are used for the various projects
Minimum Qualifications :
A Master's Degree in statistics, applied statistics, social or behavioral sciences, health sciences, business, business administration, or public policy and 4 years full time professional work developing research methodology and / or directing statistical research
Desired Qualifications :
Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and / or federal civil rights laws.
