QUALITY IMPROVEMENT DATA ANALYST - 74145

Executive Service

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.

Background Check:

This position requires a criminal 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:

TennCare is committed to improving the quality of health care for its members while maximizing the value of every dollar spent. Since its founding, TennCare has been a leader in innovation through clinical care models and delivery system payment reform. The Quality Improvement Division (QI) is an integral team within the Chief Medical Office (CMO) that is responsible for monitoring, reporting, and leading innovative strategies focused on improving clinical quality and health outcomes. The QI Data Analytics (DA) team leads key reporting, evaluation, and strategic analysis across the agency for all quality-related initiatives. Within QI, the Data Analytics team leads all analytic efforts for QI units including the Population Health Team, Social Determinants of Health Team, and the Primary Care Quality team focused on value-based outpatient programs. Additionally, the DA team collaborates closely with all other teams within 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 of the QI Data Analytics team reporting to the QI Data Analytics Director.

Key Responsibilities:

• Design and develop data analysis projects to provide insight into policies and clinical focus areas for data-informed decision making:
• Utilize knowledge of claims data to help CMO teams refine data queries and develop strong analytics to guide policy and operational decision making
• Provide data expertise in partnership with Data Analytics and CMO leadership to design dashboards and data visualizations for ongoing business accountability and data-informed decision making.
• Create presentation-ready deliverables for internal and external stakeholders. -Use TennCare data expertise to explore and identify emerging areas for clinical focus and quality improvement. Support CMO leadership analysis of data outputs.
• Continue to develop data analytics skills, including data visualization and data analysis software.
• Utilize data and analytic tools to meet quality reporting requirements and provide insights for clinical quality improvement:
• Query, collect, prepare and safeguard data -Produce key deliverables to satisfy Center for Medicare and Medicaid Services (CMS), legislative, and other ad-hoc requests for data and information.
• Provide analytics expertise to review and summarize complex reports. -Evaluate quality measures at the individual provider or aggregate level using relevant information, National Committee of Quality Assurance (NCQA) and CMS specifications.
• Design and complete complex cost and outcome projections for various programs.
• Perform quality checks of data and reports provided by Managed Care Organizations (MCO) and collaborate with the MCOs, as needed, for timely report completion. Partner with CMO teams CMO to explore and utilize data specific to each team:
• Partner with CMO teams to develop data analytics projects and dashboards.
• Train business users to understand and utilize final analytic deliverables.
• Assist the Member Medical Appeals team to develop dashboards showing key performance metrics. Identify emerging trends for targeted process improvement initiatives.
• Partner with the Dental team to complete data analysis requests, including calculation of metrics from the Dental Quality Association (DQA) and NCQA.
• Support ongoing ad hoc analytics requested by CMO teams on various initiatives, including maternal health, value-based payment, health related social needs, and behavioral health.

Minimum Qualifications:

• A master's degree in statistics, applied statistics, social or behavioral sciences, health sciences, business, business administration, or public policy and 2+ years full time professional work developing research methodology and/or directing statistical research

OR

• A bachelor's degree in statistics, applied statistics, social or behavioral sciences, health sciences, business, business administration, or public policy and 5+ years full-time professional work developing research methodology and/or directing statistical research

Desirable Qualifications:

• 2+ years of statistical and analytical experience.
• Strong coding experience in statistical software applications such as Snowflake, SAS, R, and Python.
• Strong computer skills including mastery of Microsoft (Excel, Access, Word, and PowerPoint) -Strong, clear, and concise oral and written communication skills
• Strong organizational skills, including the ability to prioritize, multi-task, and manage workload to meet specific timeframes and deadlines.
• Experience in Tableau or Power BI -Experience in healthcare field, specifically healthcare data analytics and/or with quality measurement
• Experience in survey development and analysis

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.