Data Analyst

Design, develop, and maintain analytics frameworks, data pipelines, and large-scale data models (e.g., claims/encounter, provider, member, outcomes, network data) that support healthcare quality and regulatory review, including EQR programs. 

Contribute to analytic methods, reproducible workflows, and best practices in data quality, validation, and data governance. 

Extract, transform, integrate, and analyze large healthcare datasets (including Medicaid/Medicare, managed care, provider, and performance measure data) to produce metrics related to access and timeliness, cost and utilization, outcomes, and network adequacy. 

Develop dashboards, reports, and visualizations (e.g., Power BI, Quarto, Excel) to communicate findings to contract teams, leadership, and regulatory audiences. 

Perform analyses that support the external quality review (EQR) process, including performance measure validation, access and timeliness studies, compliance file reviews, and network adequacy evaluations. 

Provide technical support to team members by reviewing analytic approaches, validating assumptions, and sharing analytic techniques such as statistical modeling, predictive analytics, and machine learning. 

Conduct ad hoc analyses to investigate quality, utilization, access, provider performance, network adequacy, and regulatory compliance metrics. 

Maintain knowledge of industry trends in healthcare quality measurement, health services research, analytic tools, and evolving regulatory expectations, particularly those related to EQR/EQRO processes. 

Work with data engineering and IT teams to ensure data architecture, warehousing, and security practices align with analytic and regulatory requirements. 

Strong hands-on experience with SQL and Python or R, including working with large data warehouses and complex data integration pipelines. 

Demonstrated experience with healthcare quality and performance measurement, including quality metrics, access and timeliness measures, network adequacy, utilization, and cost-outcome analyses. 

Knowledge of regulatory quality review processes such as EQR/EQRO and familiarity with state managed care quality review protocols; experience with organizations performing EQRO functions is a plus. 

Experience creating dashboards and visualizations for non-technical stakeholders and translating analytic results into clear business or clinical insights. 

Strong critical thinking, problem-solving, and communication skills, with the ability to work cross-functionally across clinical, regulatory, and IT teams. 

Ability to work independently, prioritize work effectively, and lead analytic initiatives without direct management responsibility. 

Bachelors’ degree in Data Science, Statistics, Biostatistics, Public Health, Health Informatics, or a related quantitative field; Master’s degree preferred. 

Minimum of 5–7 years of healthcare analytics experience, preferably in Medicaid/Medicare or managed care environments, working with large datasets (claims/encounter, provider, and member data).