Lead Value-Based Care Analytics

Education and Work Experience:

• Bachelor's Degree in Healthcare Analytics, Health Informatics, Information Systems, or related fields: Required
• Master’s Degree in Healthcare Analytics, or related fields: Preferred
• Three years' related experience in healthcare analytics or health information management: Required
• Previous experience supporting value-based care programs such as ACOs, MSSP, Medicare Advantage, Professional and Global Cap plans, and commercial risk contracts: Preferred
• Previous experience with healthcare quality measure specifications such as HEDIS, CMS quality programs, and state programs across multiple lines of business, including Medicare Advantage, Medicaid, and Commercial with appropriate comparators: Preferred
• Recent previous experience working with clinical, claims, and eligibility data: Preferred
• Previous experience in VBC reporting: Preferred

Licenses/Certifications:

• Epic application certifications based on organizational needs: Preferred

Essential Functions:

• Serve as the data steward for value-based care analytics, ensuring data integrity, accuracy, and consistency across systems. Adopt, define, and maintain data dictionaries, business rules, and validation criteria for contractual and regulated VBC measures. Partner with the VBC team, BI, IT, and analytics teams to establish data governance standards, quality assurance processes, and timely delivery. Monitor data pipelines and proactively identify and resolve data quality issues with business owners to ensure adherence to business requirements. Maintain documentation of data sources, transformations, business logic, and performance-year contracts for reporting and analytics. Enable analytics for triple aim reporting, including care gaps, high-risk populations, expense trends, out-of-network utilization, and opportunities for preventive and chronic care interventions. Partner with VBC, BI, payers, ambulatory, and care management teams to ensure accurate attribution, risk stratification, and care gap reporting. Validate and support analytics related to Annual Wellness Visits (AWVs), chronic condition management, risk (RAF) scores, and preventive care measures. Ensure care gap and outreach reporting aligns with payer program requirements and timeframes.
• Serve as a subject matter expert for VBC analytics, translating business needs into technical requirements to ensure goal achievement and appropriate payer reconciliation. Gather, document, and validate requirements from clinical, operational, regulatory, and payer-contract stakeholders. Develop functional specifications, use cases, user stories, and acceptance criteria for analytics initiatives consistent with external expectations, contracts, and national reporting requirements. Facilitate communication between business stakeholders and IT teams to ensure shared understanding, alignment, and external-submission-ready results reporting. Recommend appropriate analytic tools, approaches, and solutions to meet business needs beyond those programmatically required. Prototype, test, and validate reporting solutions in non-production environments prior to deployment, ensuring reliable cycle times for external reporting of hybrid results. Support collaborative development of dashboards, reports, and registries using Epic analytics tools such as Reporting Workbench, SlicerDicer, and Radar, partnering with IT to move validated solutions into production. Support integration and exchange of external data sources such as claims, eligibility, and care gaps with internal clinical data, meeting NCQA HEDIS hybrid reporting or fully integrated reporting standards by line of business and plan migration to meet single file integrated reporting requirements.
• Lead definition, validation, and certification of value-based care measures in accordance with contract and regulatory specifications. Develop and execute test plans for new and enhanced analytics solutions and timely exchange of data to payers. Reconcile analytics inputs and outputs against payer reports and external benchmarks. Monitor trends in VBC performance metrics and proactively identify risks, anomalies, and opportunities to ensure timely cycle times and adherence to payer and regulatory requirements. Ensure analytics are timely, accurate, and actionable to support performance improvement efforts. Maintain validation documentation and audit trails to support regulatory and audit requirements.
• Monitor federal and state regulatory updates impacting value-based care reporting, metric definitions, inclusions, and exclusions based on HEDIS and Annual Physician Fee Schedule changes. Translate new and revised measure specifications into clear business and technical requirements. Assess analytic readiness across data sources, Epic content, code mappings, measure logic, dashboards, and reporting workflows to external requirements. Support analytics related to digital patient engagement tools and outreach efforts as they relate to value-based care objectives, including remote monitoring and capture and use of patient-reported data. Ensure reporting accurately reflects patient engagement activities tied to preventive care, care gap closure, and population outreach.
• Serve as a primary liaison between value-based care, BI, quality, and IT analytics teams. Educate stakeholders on data capabilities, limitations, and appropriate interpretation as informed by contractual and regulated requirements. Translate technical concepts into clear, business-friendly language. Partner with VBC, quality, and clinical operations teams to ensure analytics support quality standard work and improvement workflows. Incorporate stakeholder feedback to continuously refine metric definitions, dashboards, and reporting outputs to ensure alignment with national standards, contractual requirements, and regulatory requirements. Participate in contract discussions to advise on data availability, feasibility, and reporting considerations for non-standard metrics.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.