About the role

Quality Analyst responsible for implementing Provider Network and Performance Improvement activities at OCHN. Analyzing data and ensuring compliance with federal and state regulations along with accreditation standards.

Responsibilities

Analyze and interpret data from various internal and external sources relative to quality assurance
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
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.

Bachelor’s degree in relevant discipline is required
Master’s degree in relevant discipline preferred
Minimum of 2 years relevant experience in quality assurance, contract administration, quality monitoring, network administration or related area, preferably in the public sector
Minimum of one (1) year experience working directly with consumers of mental health services preferred
General familiarity and understanding of the following: Medicaid Provider Manual, Principles of quality improvement, HEDIS Accreditation processes
Demonstrated knowledge and proficiency in Excel, or other relevant statistical report writing software packages
Demonstrated mathematical and technical skills
Demonstrated ability to draw inferences from data sources and present findings to management and end-users in the format of analytical reports
Demonstrated effective written and oral communication skills
Demonstrated effective interpersonal skills
Demonstrated ability to work effectively in a team environment.

Must have available means of transportation to and from OCHN and for required offsite meetings or site visits
Hybrid work schedule
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.