Clinical Quality Improvement Analyst

Blue Cross Blue Shield of Nebraska


Serve on a highly collaborative Clinical Quality Improvement team providing internal project management, leadership and facilitation of HEDIS related activities. As a member of the clinical quality team, you will serve as the subject matter expert and point of contact between business stakeholders, the HEDIS vendor and HEDIS Auditor to ensure timely and accurate reporting of quality measures.

Job Description:

  • Develop a detailed project plan to monitor and track progress, manage HEDIS data collection, audit process and submission. Identify appropriate sources, methods and locations of data, determining the best approach for report development and presenting findings. Coordinate verification of data and results.
  • Serve as the point of contact between business stakeholders and vendor with duties that include contract management, accounts payable and prioritization of project work items. Work with internal IS partners to ensure data provided to the vendor meets timeline standards and address any data quality issues. Provide training to stakeholders on vendor’s capabilities and enhancements.
  • Partner with clinical quality improvement team members and medical directors and proactively identify opportunities to solve business problems. Use data trends, benchmarking, and best practices to effectively build strategies and solutions that serve current and future needs.
  • Implement technical solutions, conduct research around best practices, monitor industry activities involving clinical quality metrics and maintain a working knowledge of technological advances.
  • Collaborate cross functionally, to include the Data Analytics team and participate in the Data Integration Community of Practice as necessary.

Required Qualifications:

  • BA/BS degree in health care or business-related field
  • Three years’ experience in health care quality data analysis, measurement and reporting.
  • Proficient in Microsoft Excel.
  • Strategic thinker with ability to analyze, develop, and document business requirements and translate those requirements into data processes to solve business issues or needs.
  • Strong verbal and written communication skills, and ability to document and explain processes accurately to both technical and non-technical stakeholders.
  • Must be self-motivated, detail-oriented, proactive and able to work well under pressure.
  • The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers.

Preferred Qualifications:

  • Working knowledge of HEDIS or similar clinical quality measures.
  • Project management experience, preferably related to HEDIS, quality improvement or other accreditation surveys.
  • Exposure to software development life cycle or technical requirements documentation.
  • Experience using analytics tools such as Power BI or similar tools.
  • Health care insurance industry experience.

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