Quality Analyst

Job Description

Job Description

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 :

Experience Requirements :

Job Specific Competencies / Skills :

Oakland Community Health Network’s Core Competencies :

Additional Information

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

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.