Clinical Quality Data Analyst (Remote Eligible - IA/SD)

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

You can also learn more about working at Wellmark here.

Use your strengths as a Clinical Quality Data Analyst! 

About the opportunity: In support of the Clinical Quality Program and HEDIS including accreditation, and compliance activities, you will manage core business processes related to the annual HEDIS season and quality improvement initiatives. You will be responsible for successful HEDIS submissions and assuring compliance with state and federal regulations and accreditation standards. Additionally, you will serve as a resource and subject matter expert to stakeholders and leaders within the organization for HEDIS and quality programs.  

About you: You are passionate about working with data and understanding the intricacies of business processes relating to membership, provider and claims data and making recommendations based on identified program gaps.  You are inquisitive, seek to understand, and aren’t afraid to ask questions. You are proficient with Microsoft Excel, skilled at analyzing data, have an eye for details, compliance, and quality – fueled by a passion for work that positively impacts member health improvement. You can successfully work independently but also enjoy building workplace relationships and collaborating with teams to bring initiatives to life.  

Candidates must have residency in Iowa or South Dakota to be considered for this position. 

Preferred Qualifications - Great to have:

• CPHQ (Certified Professional in Healthcare Quality).

Required Qualifications - Must have to be considered:

• Registered nurse with a bachelor’s degree in nursing or direct and applicable work experience.
• 2+ years of experience analyzing health care quality related data (e.g., HEDIS, ACO, quality improvement) in a health insurance, clinical operations, management care or related government setting. Experience should also reflect an ability to think strategically and ensure HEDIS program success.
• Strong attention to detail and the ability to identify, research, and analyze issues, organize information, and make appropriate decisions. Must be able to draw defensible conclusions from available information.
• Knowledgeable in regulatory standard or regulation review – e.g., NCQA, accreditation standards, governmental regulations, and confidentiality.
• Strong written and verbal communication skills with the ability to communicate and/or present complex information to stakeholders in a consumable manner.
• Strong consultation, relationship management, and critical thinking skills. Ability to develop understanding of business acumen and ask meaningful questions in order to effectively influence and consult with stakeholders.
• Demonstrated success in roles that require strong time management and workflow management skills. Ability to prioritize effectively and manage multiple priorities.
• Proficiency with Microsoft Office applications, such as Word, Excel, Outlook, PowerPoint and Teams.
• Ability to travel 5-10% as needed.

What you will do as a Clinical Quality Data Analyst:

a. In partnership with the Clinical Quality Manager-HEDIS, will provide coordination for the Wellmark HEDIS program and ensure adherence to audit standards and technical specifications. This includes collaboration and coordination of work with the contracted certified HEDIS software vendor and independent HEDIS Auditor.

b. Support the annual HEDIS season including the annual HEDIS Technical Specification update project and audit-related activities.).

c. Train and educate contract nurses. Develop and maintain training materials and resources to ensure training documents are aligned with current technical specifications.

d. Lead and manage the IRR (inter-rater reliability) testing to ensure accurate and consistent data abstraction during medical record review.

e. Medical record retrieval from provider offices, health systems, and third-party copy vendors.

f. Contribute to the HEDIS product team by providing subject matter expertise.

g. Educate and engage Wellmark internal and external stakeholders on Wellmark’s Clinical Quality Program, accreditation, and HEDIS activities.

h. Identify, recommend, and implement quality improvement initiatives that promote the delivery of appropriate identified care, coordinated to preserve member benefit dollars as well as improving member health status, and member satisfaction with Wellmark.

i. Provide quantitative and qualitative analysis of HEDIS results, identify opportunities for improvement, and measure and analyze the interventions in support of NCQA accreditation.

j. Develop quality improvement reports, dashboards and present to the Quality Improvement Committee and internal business partners.

k. Comply with regulatory standards, accreditation standards, HEDIS Technical Specifications, and internal policies. Will support assigned accreditation/audit functions during surveys as applicable and appropriate.

l. Support Wellmark’s quality improvement work plans and provide support to the Wellmark Quality Improvement Committee.

m. Provide support to the Health Services leadership team by interacting with Wellmark corporate compliance team to assess impacts from state and federal regulatory requirements and Blue Cross and Blue Shield Association mandates.

n. Support the Business Continuity Planning and preparation process.

o. Other duties as assigned.

Remote Eligible: You will have the flexibility to work where you are most productive. This position is eligible to work fully remote. Depending on your location, you may still have the option to come into a Wellmark office if you wish to. Your leader may ask you to come into the office occasionally for specific meetings or other ‘moments that matter’ as well.  

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]

Please inform us if you meet the definition of a "Covered DoD official".