Healthcare Performance Quality Lead in Mountlake Terrace, WA

$80K - $100K(Ladders Estimates)

Premera Blue Cross   •  

Mountlake Terrace, WA 98043

Industry: Finance & Insurance


5 - 7 years

Posted 56 days ago

Join Our Team: Do Meaningful Work and Improve People's Lives

Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we're creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

The Healthcare Performance Quality Lead is responsible for quality-specific aspects of Premera's Healthcare Performance program that aims to know and understand value and performance of providers to enable purchasing healthcare differently, transforming payment methodologies, and optimizing decisions at point of care. This includes identifying and sourcing data elements for quality measures and developing comprehensive quality evaluation processes that support company initiatives to improve member health, safety, and service. The incumbent provides subject matter expertise on quality measures and will collaborate with internal and external stakeholders to facilitate quality activities and reporting. In addition, this position identifies and manages selected vendor solutions, gap analyses, and consultation with leadership on ways to improve provider performance.

Job Responsibilities:

  • Aggregate and manage a library of quality measures and available data sources. Converge data and sources to holistically assess the quality and performance of the provider network.
  • Apply technical knowledge of clinical quality measure sets and sources to daily work, such as National Quality Forum (NQF), National Committee or Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), and CMS national programs such as Merit Based Incentive Programs (MIPS) and Comprehensive Primary Care (CPC)
  • Support research and acquisition efforts to obtain data sources for measuring quality, including evaluating vendor solutions that measure provider quality performance. Contract and manage vendor relationships as applicable.
  • Assess, build and manage frameworks and methodologies for how to assess provider performance across specialties and provider types.
  • Profile and measure provider performance. Understand variation in care across Premera's network and translate those variations to members and customers.
  • Work cross-functionally with Healthcare Economic (HCE) and Corporate Data & Analytics (CD&A) to integrate quality analytics into a broader provider profiling capability.
  • Apply skills in coding and programming languages such as Structured Query Language (SQL) to daily informatics and data visualization work
  • Analyze areas of opportunity for improvement in quality performance of Premera's network to inform internal product and network design.
  • Create visual analytics to support the business in understanding variation in care. Consult with and educate stakeholders on how to apply such analytics to their work.
  • Apply daily work to a vision set forth to help shape the development of a new program.
  • Perform other duties as assigned.

Required Qualifications:

Candidates must have:

  • Bachelor's degree and Seven (7) years of experience in a healthcare setting,
  • Two to three (2-3) years of strong data analytics experience including:
  • Experience with quality measure sets, sources and uses such as NQF, NCQA, HEDIS, MIPS and CPC.
  • Intermediate experience with SQL or SAS
  • Intermediate experience with data visualization
  • Experience with Visual Basic for Applications

Preferred Qualifications:

  • Experience analyzing provider contracting initiatives.
  • Advanced experience with SQL or SAS
  • Advanced experience with data visualization
  • Experience with programming languages such as Python

Knowledge, Skills and Abilities:

  • Advanced knowledge of clinical quality measures.
  • Solid understanding of healthcare domains of quality and the related sources and uses.
  • Excellent verbal and written communication skills as well as the ability to present to leaders.
  • Knowledge of statistics and mathematical methods.
  • Strong analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy.
  • Experience with data visualization.
  • Self-led with strong drive to execute work based on a vision.



What we offer

  • Medical, vision and dental coverage
  • Life and disability insurance
  • Retirement programs (401K employer match and pension plan)
  • Wellness incentives, onsite services, a discount program and more
  • Tuition assistance for undergraduate and graduate degrees
  • Generous Paid Time Off to reenergize
  • Free parking

Valid Through: 2019-10-14