hedis analyst

EmblemHealth

<div></div><div><div>Summary of Job</div><div>
Perform provider and member outreach to reconcile member records and validate data entry to support continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) rates and STAR measures for the enterprise. Facilitate provider and member outreach supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes. Daily telephonic outreach to secure appointments with pharmacists and/or vendors to close gaps in care. Support efficient medical record retrieval for HEDIS medical record review and HEDIS supplemental data collection activities. Track calls for all lines of business related to the MTM, OMW, and Medication Adherence quality measures, reporting weekly completion statistics. Produce and process department mailings to members and physicians. Monitor internal mailboxes for department faxes and calls. Collaborate with internal departments in order to administer the MTM, OMW, and Medication Adherence quality measures.</div><div>
Responsibilities</div><ul><li>
Work closely with Clinical Pharmacist(s), Registered Nurses and Data Analyst(s) to prioritize members for outreach who fall in HEDIS measures including but not limited to Medication Adherence and OMW (Osteoporosis Management in Women who had a fracture) and the STAR measure MTM (Medication Therapy Management) Program. 
</li><li>
Perform daily telephonic outreach to secure appointments with pharmacists and/or vendors to close gaps in care supporting Enterprise goals. 
</li><li>
Perform daily provider and member outreach supporting the MTM, OMW, and Medication Adherence quality measures to ensure member receipt of important clinical services to improve member health outcomes. 
</li><li>
Prepare and execute member and provider mailings. 
</li><li>
Collaborate with providers and internal departments to ensure the receipt and correct processing of all supplemental data related to HEDIS claims and records and assist in correcting discrepancies. 
</li><li>
Maintain high data integrity while adhering to HIPAA standards and protecting patient information. 
</li><li>
Perform provider outreach to verify and document member&rsquo;s appropriate medical diagnoses and subsequent treatments both by telephone and in writing. 
</li><li>
Coordinate call tracking and provide statistics to stakeholders. 
</li><li>
Intake and organize data from other departments while ensuring proper compliance with all CMS regulations, policies and procedures. 
</li><li>
Other duties/projects as assigned.</li></ul>
<div><div>Qualifications</div><ul><li>
High School Diploma (Required) 
</li><li>
College Degree (Preferred) 
</li><li>
Pharmacy Technician License (Preferred) 
</li><li>
Minimum of 1 year direct customer service experience in a healthcare setting (Required) 
</li><li>
Excellent telephonic and customer service skills (Required) 
</li><li>
Experience analyzing data and building action plans based upon data outcomes (Required) 
</li><li>
Personal motivation to achieve set goals (Required) 
</li><li>
Flexibility and ability to adjust workflow to achieve company goals (Required) 
</li><li>
Experience with or knowledge of Electronic Medical Records (Preferred) 
</li><li>
Knowledge of or experience with HEDIS, STAR ratings, and/or quality improvement (Preferred) 
</li><li>
Experience in a managed care health services environment (Preferred) 
</li><li>
Experience in data collection, data entry and analysis (Preferred) 
</li><li>
Knowledge of Excel and other analytical tools (Preferred)</li></ul>
</div><div>Additional Information
<ul><li>Requisition ID: 1000003045</li>
<li>Hiring Range: $39,960-$70,200</li></ul></div></div>

Quality Outreach Specialist - Remote

NeighborHealth

<div><div>Thank you for your interest in a career at NeighborHealth, formerly East Boston Neighborhood Health Center!
As one of the largest community health centers in the country, NeighborHealth is proud to serve the greater Boston area with a strong commitment to the health and well-being of our patients and communities.</div><div>
Whether you're a nurse or physician providing direct care, a manager leading dedicated teams, or part of the essential support staff who keep our operations running smoothly &mdash; every role at NeighborHealth is vital. Together, we&rsquo;re advancing medicine and delivering the best care experience for our patients and community!</div><div><div><div>
Interested in this position? Apply online and create a personal candidate account!</div></div></div>
Current Employees of NeighborHealth- Please use our internal careers portal to apply for positions.
To learn more about working at NeighborHealth and our benefits, please visit out our Careers Page.
Time Type:
Full time
Department:
Quality
All Locations:
10 Gove Street &ndash; Taylor Building, 151 Orleans Street, 20 Maverick Square &ndash; Cradock Building, 300 Ocean Avenue &ndash; Revere, 79 Paris Street
Position Summary:
NeighborHealth is seeking an experienced Quality analyst. This role is ideal for a professional with deep expertise in data management, EMR (Epic) reporting, dashboard build and management, data analysis, and Quality/Process improvement, with an ability to work collaboratively in cross-functional teams and translate data into actionable steps.
The Quality Analyst plays a key role in advancing the health center&rsquo;s strategic projects on quality, population health, and performance improvement. This position is responsible for collecting, validating, analyzing, and reporting clinical and operational data to support organizational priorities. Working closely with senior leadership, the analyst produces dashboards, supports UDS and regulatory reporting, and provides actionable insights that drive improvements in patient outcomes and overall performance.
The successful candidate will be able to perform the following responsibilities:
Quality Measurement &amp; Reporting<ul><li>
Develop, maintain, and analyze quality performance reports including UDS, HEDIS, PCMH, CMS, and internal quality measures.</li><li>
Extract, validate, and manage data from Epic using Reporting Workbench and other internal reporting tools.</li></ul>
What You&rsquo;ll Bring<ul><li>
Bachelor&rsquo;s degree in Public Health, Healthcare Administration, Data Analytics, or related field.</li><li>
1&ndash;3 years of experience in healthcare quality, data analysis, or population health.</li><li>
Strong proficiency in Microsoft Excel.</li><li>
Experience with data visualization (charts, graphs, dashboards).</li><li>
Familiarity with quality improvement methodologies.</li><li>
Knowledge of SQL.</li><li>
Experience with Epic Reporting Workbench, Slicer Dicer, or other Epic reporting tools.</li><li>
Understanding of UDS, HEDIS, PCMH, and other clinical quality metrics.</li></ul>
Preferred<ul><li>
Epic Cogito certification.</li><li>
Experience working in an FQHC or community health center environment.</li><li>
Additional experience with other reporting/analytics tools.</li><li>
Demonstrated background supporting population health and value based care initiatives.</li></ul><ul><li>
Produce monthly and quarterly dashboards aligned with organizational quality priorities.</li><li>
Track performance against quality goals and communicate updates to leadership and operational teams.</li></ul>
Data Analysis &amp; Visualization<ul><li>
Clean, organize, and analyze large datasets using Microsoft Excel and other tools.</li><li>
Create clear, compelling charts and visualizations to support data-driven decision making.</li><li>
Identify patterns and trends; collaborate with teams to design actionable and measurable improvements.</li></ul>
Quality Improvement Support<ul><li>
Participate in quality initiatives using PDSA cycles, root cause analysis, workflow mapping, and related methodologies.</li><li>
Support clinical and operational teams with data validation and monitoring intervention outcomes.</li><li>
Assist in documentation and reporting for PCMH and accreditation requirements.</li></ul>
Operational &amp; Clinical Support<ul><li>
Support population health activities including panel management, care gap reporting, and related analytics.</li><li>
Provide routine and ad‑hoc data analysis for clinical and administrative teams.</li><li>
Conduct ongoing audits and validation to maintain high standards of data integrity.</li></ul>
Other Duties:
Please note, this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
EEO &amp; Accommodation Statement:
NeighborHealth is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to HRrecruit@NeighborHealth.com or call 617-568-4480 to let us know the nature of your request
Federal Trade Commission Statement: 
According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website. We do not ask or require downloads of any applications, or &ldquo;apps.&rdquo; Job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
E-Verify Program Participation Statement:
NeighborHealth participates in the Electronic Employment Verification Program, E-Verify. As an E-Verify employer, all prospective employees must complete a background check before beginning employment.</div>

Analyst, Quality

Imperial Beach Community Clinic

<div>RESPONSIBLE TO: CEO
DESCRIPTION: 
The Clinical Informatics Manager is responsible for the implementation, build, analysis, testing, training, and maintenance of health informatic system applications. Coordination with management, vendors, and other departments would be required as will the ability to use critical thinking, prioritize assignments and address open issues. Excellent customer service and provider orientation are critical personal characteristics of this position as well as knowledge of documentation and reporting requirements for Primary Care - Patient Centered Medical Homes (PCMH) and Federal Qualified Health Centers (FQHC). 
 
DUTIES AND RESPONSIBILITES:<ul><li>
Serve as an expert user of health informatic system applications, primarily eClinicalWorks (eCW)</li><li>
Collect and analyze clinic workflows to build and customize the eClinicalWorks (eCW)</li><li>
Establish, manage, and coordinate end-user workflows to meet EHR, governmental (UDS), PCMH, and insurance regulation (HEDIS) requirements</li><li>
Identify and implement utilization best practice strategies in the EHR for tracking and documentation</li><li>
Create and provide training to facility resources, provide one-on-one guidance with physicians, nurses, and other staff to assist with questions or procedures</li><li>
Develop and maintain end user documentation and training materials</li><li>
Actively listens to concerns and requests to develop a plan of action beneficial to all parties.</li><li>
Provide insights and support for the right clinical &amp; software operational processes and behaviors</li><li>
Identify and analyze functional and technical cases and provide a resolution</li><li>
Keeps abreast of new trends in clinical information systems and can appropriately apply technology</li><li>
Provide accurate software information to the development team, maintain status of problem resolution and update team leads</li><li>
Identify opportunities for activities related to team development, employee engagement activities, and achievement of department goals and objectives</li><li>
Share knowledge and practical experience with eClinicalWorks (eCW) on product/technical skills to continually improve the capability and effectiveness of the Services/Support teams</li><li>
Mediate and resolve EHR issues with application vendors</li><li>
Work with coders</li><li>
All other duties as assigned</li></ul>
MINIMUM QUALIFICATIONS (Education/Experience/Knowledge):<ul><li>
Bachelor&rsquo;s Degree</li><li>
eClinicalWorks (eCW) experience required</li><li>
Clinical Experience in Healthcare</li><li>
Technically inclined with strong analytical, critical thinking and reporting skills</li><li>
Strong leadership, communication (verbal &amp; written), negotiation and relationship building skills</li><li>
Self-starter and organizer who can serve as a project lead analyst with high energy and drive to meet the needs of a demanding clinical practice</li><li>
Knowledge of healthcare business systems and Electronic Medical Records</li><li>
Proficiency in Microsoft Office including Excel, Outlook, Word, PowerPoint.</li></ul>
PREFERRED QUALIFICATIONS:<ul><li>
Strong user of technology solutions such as having been a user or managing users for the Allscripts EHR solution in a healthcare provider setting or experience in a customer facing role with a technology provider</li><li>
Demonstrated ability to make both business process and system recommendations based on business problems and organizational requirements</li><li>
Direct experience in a case management or clinical coordination setting, particularly with population health concepts or five or more years&rsquo; experience driving clinically oriented software deployment projects with a variety of stakeholders in a healthcare provider setting</li><li>
Demonstrated complete understanding of EHR solution(s) through application build, testing, and configuration</li><li>
Five years of clinical experience in healthcare</li><li>
Knowledge of FQHC (Primary Care) operations, PCMH, UDS and HEDIS preferred</li><li>
Knowledge of healthcare business systems and Electronic Medical Records &ndash; especially Allscripts PEHR &amp; PM, Arcadia, i2i, Phreesia and Patient Link</li><li>
Experience and/or understanding of ICD-10-CM and CPT codes</li></ul></div>

Clinical Informatics Manager

Blue Shield of California

<div>
 
 Job Description
 
 
 
 
 Your Role
 
 
 
 The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work.
 
 
 Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
 
 
 
 Responsibilities
 
 
 
 
 Your Work
 
 
 
 
 In this role, you will:
 
 
 
 <ul>
 <li>
 Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
 </li>
 <li>
 Educate members on missing care gaps and provide encouragement to obtain missing service.
 </li>
 <li>
 Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
 </li>
 <li>
 Manage and maintain HEDIS files and medical records
 </li>
 <li>
 Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
 </li>
 <li>
 Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
 </li>
 <li>
 Research member claims and encounters to identify accurate pursuit information for medical record retrieval
 </li>
 <li>
 Review medical records and identify elements for compliance
 </li>
 <li>
 Create and maintain detailed logs of member and provider interactions
 </li>
 <li>
 Ability to de-escalate situations
 </li>
 <li>
 Assist in onboarding contingent workforce for HEDIS and outreach projects
 </li>
 <li>
 EMR and vendor portal medical record retrieval
 </li>
 <li>
 Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
 </li>
 <li>
 Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
 </li>
 <li>
 Ability to work independently in a fast-paced environment with minimal errors
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Your Knowledge and Experience
 
 
 
 <ul>
 <li>
 Requires a high school diploma or equivalent
 </li>
 <li>
 Requires limited knowledge of systems and procedures
 </li>
 <li>
 Typically, has limited or no prior experience
 </li>
 <li>
 Communication and interpersonal skills
 </li>
 <li>
 Must be organized with the ability to keep accurate notes and records
 </li>
 <li>
 Customer service experience is preferred
 </li>
 <li>
 HEDIS knowledge strongly preferred
 </li>
 <li>
 Critical thinking skills
 </li>
 <li>
 Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches
 
 
 </li>
 </ul>
 
 Hybrid Virtual Work
 
 
 
 This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
 
 
 
 About The Team
 
 
 
 
 About Blue Shield of California
 
 
 
 As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
 
 
 At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
 
 
 To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
 
 
 Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
 
 
 
 Our Values:
 
 
 
 <ul>
 <li>
 Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
 </li>
 <li>
 Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
 </li>
 <li>
 Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
 
 
 </li>
 </ul>
 
 Our Workplace Model
 
 
 
 We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
 
 
 <ul>
 <li>
 For most teams, this means coming into the office two days per week.
 </li>
 <li>
 Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
 </li>
 <li>
 For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
 
 
 </li>
 </ul>
 The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
 
 
 
 Physical Requirements:
 
 
 
 Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
 
 
 Please click here for further physical requirement detail.
 
 
 
 Equal Employment Opportunity:
 
 
 
 External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
</div>

Clinical Quality Coordinator, Entry

<div>Your Role 
 
The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work. 
 
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</div>
 <div>Your Work
In this role, you will:
<ul><li>Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
</li><li>Educate members on missing care gaps and provide encouragement to obtain missing service.
</li><li>Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
</li><li>Manage and maintain HEDIS files and medical records
</li><li>Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
</li><li>Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
</li><li>Research member claims and encounters to identify accurate pursuit information for medical record retrieval
</li><li>Review medical records and identify elements for compliance
</li><li>Create and maintain detailed logs of member and provider interactions
</li><li>Ability to de-escalate situations
</li><li>Assist in onboarding contingent workforce for HEDIS and outreach projects
</li><li>EMR and vendor portal medical record retrieval
</li><li>Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
</li><li>Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
</li><li>Ability to work independently in a fast-paced environment with minimal errors</li></ul></div>
 <div>Your Knowledge and Experience
<ul><li>Requires a high school diploma or equivalent
</li><li>Requires limited knowledge of systems and procedures
</li><li>Typically, has limited or no prior experience
</li><li>Communication and interpersonal skills
</li><li>Must be organized with the ability to keep accurate notes and records
</li><li>Customer service experience is preferred
</li><li>HEDIS knowledge strongly preferred
</li><li>Critical thinking skills
</li>Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches 
<li>
</li></ul>Hybrid Virtual Work
 
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.</div>
 <div>ABOUT THE TEAM 
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
Our Values:
<ul><li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div>Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
<ul><li>For most teams, this means coming into the office two days per week.
</li><li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</li><li>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</li></ul>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</div>Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. 
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</div>

Elevance Health

<div>Business Information Analyst II - HEDIS Quality Analytics
Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
PLEASE NOTE: This position is not eligible for current or future visa sponsorship.
Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center&mdash;connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together. 
 
Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.
The Business Information Analyst II will be responsible for analyzing, reporting and developing recommendations on data related to multiple, varied business metrics.
How You Will Make an Impact:<ul><li>
Creates and maintains databases to track business performance.</li><li>
Analyzes data and summarizes performance using summary statistical procedures.</li><li>
Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.</li><li>
Creates and publishes periodic reports, makes necessary recommendations, and develops ad hoc reports as needed.</li><li>
May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.</li></ul>
Minimum Requirements:<ul><li>
Requires a BS/BA degree in a related field and a minimum of 2 years related operational and/or data analysis experience, experience in database structures, and standard query and reporting tools; or any combination of education and experience which would provide an equivalent background.</li></ul>
Preferred Skills, Capabilities, &amp; Experiences:<ul><li>
Understanding multiple data sources and formats and utilizing multiple data systems to analyze HEDIS results is preferred.</li><li>
Experience with relational databases and knowledge of query tools and statistical software is strongly preferred including SQL.</li><li>
Strong MS Office command. Power BI skills experience a plus.</li><li>
Experience with Jira, ServiceNow, or other ticketing systems preferred.</li><li>
Alteryx and Python experience a plus.</li></ul> 

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities &ndash; and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.</div>

Business Information Analyst II - HEDIS Quality Analytics

Mac Care

Job SummaryWe are seeking a detail-oriented Clinical Data Analyst with strong expertise in healthcare analytics and hands-on experience working with clinical research data. This role will support our Value-Based Care (VBC) and MSSP initiatives, while also contributing to the analysis and interpretation of clinical datasets from research and quality improvement programs.The ideal candidate will transform complex healthcare and clinical research data into actionable insights to improve patient outcomes, ensure regulatory compliance, and drive data-informed decision-making.Key Responsibilities<ul><li>Analyze and manage CCLF, HCC, and quality data for MSSP and Value-Based Care programs.</li><li>Work with clinical research datasets (e.g., study data, patient cohorts, outcomes data) to support research analysis and reporting.</li><li>Develop and maintain interactive dashboards using Power BI to track performance, clinical outcomes, and quality metrics.</li><li>Perform data extraction, transformation, and cleaning using Power Query and SQL.</li><li>Collaborate with clinical, research, and operations teams to identify high-risk populations and monitor quality measures.</li><li>Support CMS reporting, risk adjustment analysis, and quality improvement initiatives.</li><li>Assist in clinical study data validation, reconciliation, and audit readiness.</li><li>Ensure data integrity, accuracy, and compliance with healthcare regulations (HIPAA, CMS guidelines).</li><li>Translate complex datasets into clear insights and recommendations for leadership and stakeholders.</li></ul>Requirements<ul><li>Bachelor&rsquo;s degree in Computer Science, Data Analytics, Public Health, Biostatistics, or a related field.</li><li>2&ndash;4 years of experience in healthcare data analytics, clinical research data analysis, or value-based care programs.</li><li>Hands-on experience working with clinical datasets, research data, or population health data.</li></ul>Technical Skills<ul><li>Power BI (2+ years) &ndash; dashboarding and visualization</li><li>Power Query (2&ndash;3 years) &ndash; data transformation</li><li>SQL &ndash; data extraction and manipulation</li><li>Strong skills in data cleaning, validation, and analysis</li></ul>Domain Knowledge<ul><li>Understanding of CMS programs, MSSP, and HCC risk adjustment</li><li>Familiarity with clinical research processes, datasets, and reporting standards</li><li>Experience with EMR/EHR systems and population health tools</li></ul>Preferred Qualifications<ul><li>Experience supporting clinical trials, registry data, or outcomes-based research</li><li>Knowledge of study design, cohort analysis, and healthcare quality measures (e.g., HEDIS)</li><li>Exposure to statistical tools (R, Python, or similar) is a plus</li></ul>Job Type: Full-timeWork Location: In person

Clinical Data Analyst

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Business Information Analyst II - HEDIS Quality Analytics

Clinical Data Analyst