Principal Clinical Cost & Quality Analyst

  • Jersey City, NJ
  • Posted 17 hours ago | Updated 2 hours ago

Overview

Hybrid
Depends on Experience
Contract - W2
Contract - Independent
Contract - 6 Month(s)

Skills

healthcare analytics
costing analysis
SQL
R
Python
or SAS
Epic
Cerner
CDHA
CHFP
CPHQ

Job Details

  1. Conduct comprehensive cost-benefit analyses of clinical programs, service lines, and quality improvement initiatives, quantifying both financial impact and patient outcomes.
  2. Develop and maintain sophisticated costing models using activity-based costing, service line analytics, and DRG optimization to identify opportunities for operational efficiency.
  3. Partner with executive stakeholders to design and implement value-based care strategies, including risk adjustment modeling and contract performance analysis.
  4. Lead cross-functional teams in analyzing clinical variation, resource utilization, and practice patterns to standardize care delivery and reduce unnecessary costs.
  5. Create executive-level dashboards and presentations that synthesize complex clinical and financial data into clear, actionable recommendations.
    1. Analyze quality metrics including CMS Star Ratings, HEDIS measures, Core Measures, and patient safety indicators to identify improvement opportunities and predict financial implications.
    2. Collaborate with clinical departments to implement cost-effective care pathways while maintaining or improving quality outcomes.
    3. Perform predictive modeling to forecast the impact of clinical interventions on both cost and quality metrics.
    4. Support strategic planning initiatives by providing data-driven insights on market trends, competitive positioning, and growth opportunities.
    5. Mentor junior analysts and serve as subject matter expert on healthcare economics and clinical data interpretation.
    6. Evaluate ROI of new medical technologies, clinical programs, and capital investments from both financial and clinical perspectives.
    7. Ensure compliance with regulatory reporting requirements and support responses to payer audits and quality reviews.
    8. Other duties and/or projects as assigned.
    9. Adheres to HMH Organizational competencies and standards of behavior.

    Education, Knowledge, Skills, and Abilities Required:

    1. Bachelor's degree in Nursing, Medicine, or other clinical field required
    2. Active clinical license (RN, MD, PharmD, PA, or equivalent) with minimum 5 years of direct patient care experience
    3. Minimum 7 years of progressive experience in healthcare analytics with at least 4 years focused on costing analysis
    4. Expert knowledge of healthcare finance including DRG methodology, CPT coding, activity-based costing, and service line profitability
    5. Advanced proficiency in SQL, visualization tools (Power BI, Looker, Tableau) and statistical analysis software (R, Python, or SAS)
      1. Deep understanding of quality metrics, value-based care models, and regulatory requirements (CMS, Joint Commission, NCQA)
      2. Proven experience presenting complex analyses to C-suite executives and board members
      3. Strong knowledge of clinical workflows, care delivery models, and healthcare operations
      4. Experience with major EMR systems (Epic, Cerner) and cost accounting systems (Strata, EPSi, Oracle)
      5. Demonstrated ability to influence clinical practice through data-driven insights
      6. Expert understanding of healthcare reimbursement models including fee-for-service, bundled payments, and capitation
      7. Strong project management skills with ability to lead multiple complex initiatives simultaneously
      8. Exceptional written and verbal communication skills with ability to translate technical concepts for diverse audiences
      9. Knowledge of population health management and risk stratification methodologies
      10. Understanding of clinical documentation improvement (CDI) and its impact on quality metrics and reimbursement
      11. Ability to maintain confidentiality and handle sensitive financial and clinical information
      12. Critical thinking skills with ability to challenge assumptions and drive evidence-based decision making
      13. Excellent written and verbal communication skills.
      14. Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

      Education, Knowledge, Skills, and Abilities Preferred:

      1. Master's degree in Business Administration (MBA), Health Administration (MHA), Public Health (MPH), or Health Informatics
        1. Certification in Healthcare Financial Management (CHFP) or Certified Professional in Healthcare Quality (CPHQ)
        2. Experience with machine learning applications in healthcare analytics
        3. Lean Six Sigma certification (Green Belt or higher)
        4. Published research or presentations at national healthcare conferences
        5. Experience with Medicare Advantage or managed care organizations

        Licenses and Certifications Required:

        1. Active clinical license in good standing (RN, MD, DO, PharmD, PA, NP, or equivalent)

        Licenses and Certifications Preferred:

        1. Certified Health Data Analyst (CHDA)
        2. Certification in Healthcare Financial Management (CHFP)
        Certified Professional in Healthcare Quality (CPHQ)
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