Senior Quality Analyst (PIC)

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The primary function of the Senior Quality Analyst position is to support the data analysis, monitoring, evaluation, and reporting activities within the Partnership in Care (PIC) department. This position will conduct ongoing analyses that will support PIC operations in five key areas: regulatory compliance, care management (including Advanced Care Management program), quality/performance measurement, special projects/grants, and administrative functions. The role will support the strategic goals of the PIC department to ensure that all MetroPlusHealth HIV positive members are engaged in care, virally suppressed, and receiving appropriate services. The role requires working knowledge of Microsoft SQL Server, Tableau, and MS Excel.

Job Description

• Oversees reporting of HIV SNP’s Advanced Care Management (ACM) program activities.
• Coordinate and collaborate with IT and Analytics departments, as needed, to report on ACM program activities.
• Analyzes ACM data to ensure the timeliness, completeness, and accuracy of encounter data submission.
• Monitors and evaluates ACM program activities and outcomes.
• Monitors HIV viral load lab data collection to support viral load suppression quality improvement efforts.
• Performs analysis related to SNP audits and compliance activities to ensure adherence with regulatory requirements.
• Analyze SNP recertification and membership data to monitor trends in SNP enrollments and disenrollments.
• Analyze ACD line metrics to monitor abandonment rates.
• Monitor HIV SNP reward metrics for engagement in care.
• Designs, coordinates, and implements analytical business and technology solutions, i.e., Microsoft SQL Server, Tableau, and MS Excel.to support PIC operations.
• Develops a comprehensive data reporting, evaluation, and monitoring plan for PIC department.
• Analyzes and monitors contractual compliance and business operations to evaluate inefficiencies (e.g., member enrollment, eligibility verification, retention).
• Analyzes monthly claims data alongside other data sources (gaps in care, CRG scores, etc.) to create member profiles and acuity scores.
• Identifies, prioritizes, and distributes members based on risk and acuity for outreach to the PIC care management team.
• Measures and tracks key performance indicators and targets to effectively monitor PIC department activities including productivity and quality outcomes.
• Performs extraction, import, and export of data from diverse data sources including various database applications.
• Packages data from a variety of reports into a monthly and quarterly PIC departmental dashboard.
• Provides training to internal and external staff regarding analyses, reports, or other relevant topics.
• Ensures accuracy and conducts validation of all reports and analyses.
• Performs statistical analyses to support monitoring and evaluation of PIC department.
• Develops and prepares reports, business presentations, and other materials.
• Assist with the identification, collection, input, and assembly of documents as required for external and internal audits.
• Assist with analyses and reporting for special projects as assigned.
• Attends approved in-service and external education and training as per department directives.
  
  
  

Minimum Qualifications

• Master’s degree in public health, health administration, business administration, or information technology preferred. Bachelor’s degree required.
• A minimum of five years of analytics, programming, application, or reporting development experience is required.
• Experience using analytics/BI packages (e.g., SAS, SQL, R, Cognos, Tableau, etc.) is required.
• Must have advanced working knowledge of Microsoft Office application including Excel and Access.
• Prefer experience and knowledge of Managed Care plan operations or Health Services administration.
• Knowledge of concerns of persons living with HIV/AIDS is preferred.
  
  
  

Professional Competencies

• Integrity and Trust
• Customer Focus
• Displays strong communication, interpersonal, and organizational skills across all levels coupled with effective problem solving, conceptual thinking, quantitative, and analytical skills.