Quality Analyst

Job Summary

The Quality Analyst is responsible for the implementation of Provider Network and Performance Improvement activities in accordance with the mission and strategic goals of Oakland Community Health Network, federal and state laws, regulations, and accreditation standards. This includes the facilitation of improvement teams, report preparation, data analysis, performance monitoring, developing standards, preparation for accreditation reviews, implementing improved processes and systems.

Essential Functions

• Analyze and interpret data from various internal and external sources relative to quality assurance by:
• Importing, cleaning, and transforming data from OCHN Information System and other external sources and transforming it into information for purposes of drawing conclusions for management decision making.
• Presenting data in the format of charts, graphs, and tables for management reports
• Present, interpret, discuss, or write about conclusions, inferences and results gained from research data.
• Conducting exploratory data analysis and creation of data reports as required.
• Participate in internal audits to ensure compliance of providers, such as credentialing file and policy reviews, or investigations of suspected fraud, waste, or abuse.
• Participate in preparation for external reviews by MDHHS, National Committee for Quality Assurance (NCQA) and Health Services Advisory Group (HSAG).
• Data analysis, interpretation, and reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures and performance indicators for continued quality performance, compliance, and improvement. 
• Coordinate and ensure the organization's efforts to comply with MDHHS and CMS Provider Network requirements. 
• Lead, develop and implement strategies in network management to include conducting research and developing policies and procedures as required. 
• Develop monitoring tools to measure provider performance. Analyze performance data and prepare outcome reports for OCHN and providers. 
• Develop and score Provider Evaluations to annually assess the provider agencies and assign a rating. 
• Additional duties as assigned. 

Job Requirements and Qualifications

Education: 

• Bachelor's degree in relevant discipline is required.
• Master’s degree in relevant discipline preferred.

Experience Requirements:

• Minimum of 2 years relevant experience in quality assurance, contract administration, quality monitoring, network administration or related area, preferably in the public sector.  Minimum of one (1) year experience working directly with consumers of mental health services preferred.
• General familiarity and understanding of the following:
• Medicaid Provider Manual.
• Principles of quality improvement.
• HEDIS
• Accreditation processes.

Job Specific Competencies/Skills:

• Demonstrated knowledge and proficiency in Excel, or other relevant statistical report writing software packages.
• Demonstrated mathematical and technical skills.
• Demonstrated ability to draw inferences from data sources and present findings to management and end-users in the format of analytical reports.
• Demonstrated effective written and oral communication skills.
• Demonstrated effective interpersonal skills.
• Demonstrated ability to work effectively in a team environment.

Oakland Community Health Network’s Core Competencies:

• Interacting with others in a way that gives them confidence in one’s intentions and those of the organization; demonstrating loyalty to the organization and its mission and values; maintaining social, ethical, and organizational norms; firmly adhering to codes of conduct and ethical principles. (Integrity/Building Trust)
• Making customers and their needs a primary focus of one’s actions; developing and sustaining productive customer relationships, recognizing that the ultimate customer is the person served. (Customer Focus)
• Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application. (Continuous Learning) 
• Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence in addition to consciously adopting organizational standards of excellence. (Work Standards)
• Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message. (Communication)

Additional Information

 (Travel required, physical requirements, schedules, etc.):

• Must have available means of transportation to and from OCHN and for required offsite meetings or site visits.
• Hybrid work schedule. 

OCHN is committed to building a diverse team and fostering an inclusive and equitable culture. We are proud to be an equal opportunity employer that embraces and encourages our employees’ differences. This includes (but is not limited to) ability, age, color, family type, gender expression and identity, individual expression, medical conditions, national origin, pregnancy, race, religion, sexual orientation, veteran status, and all other diverse and wonderful characteristics.