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As we empower every New Yorker
to live the healthiest life possible.

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Job Details

QM Operations Senior Analyst

Job Ref: 57790
Category: Quality Assurance
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $40,764.00
Salary Range: $40,764.00 - $93,783.00

Marketing Statement

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 


Job Description

The primary function of the QM Operations Senior Analyst is to support data management functions that operationally and technically support Quality Management Operations activities. The QM Operations Senior Analyst should be able to work independently to develop analytical and operational business solutions. The role requires advanced working knowledge of SQL, MS Access, MS Excel & VBA. This position will function as a developer of internal tracking tools and quality assurance tests and will also conduct ongoing analyses that will support QM operations and QM improvement specialists in identifying target populations and efficient approaches to improve quality scores. The role will also mentor and train staff on all applications and reports developed. The position may also be responsible for duties tied to the development of new programs and initiatives as assigned by the Director of QM Operations.

Job Description


  • Executes all regular transaction processes necessary to maintain QM Operations records and databases.
  • Perform extracting, importing, and exporting of data in various database applications.
  • Designs, coordinates, and implements analytical business and technology solutions, i.e. MS Access databases, SAS, SQL programs, Crystal Reports to support QM Operations activities.
  • Able to query from large scale database
  • Provide trainnng to internal and external staff regarding analyses, reports or other relevant topic.
  • Ensure accuracy of all reports.
  • Assists in implementation, testing, and validating of supplemental data collected from providers
  • Communicate, as needed, with the NYS or city Departments of Health on relevant analyses.
  • Performs data reconciliations, ensures that MetroPlus feeds to vendors is vetted and output is thoroughly QA’ed.
  • Performs statistical analyses to identify data anomalies.
  • Provides technical mentorship to QM Ops Specialists, Quality Review Leads and Quality Improvement Specialists
  • Functions as mid-level escalation support for all applications; Escalate data issues needing process re-engineering.
  • Assist in preparation of data reports, training materials, business presentations, publications, marketing collaterals, and other educational materials. Trains staff as necessary.
  • Technically and operationally assists in the re-design of the annual hybrid Medical Record Review (MRR) Project.
  • Other duties as assigned by Director of QM Operations.

Minimum Qualifications

  • Master’s degree in public health, health administration, business administration or information technology preferred. Bachelor’s degree required.
  • A minimum of 5 years programming, application or reporting development experience and analytical experience (SAS, SQL, Crystal Reports etc).
  • Experience using analytics / BI packages (e.g. SAS, R, SQL, Cognos, Business Objects) to build client analysis solutions.
  • Must have advanced working knowledge of Microsoft Office applications including Word, Excel, PowerPoint, Visio and Access.
  • Prefer experience working in the development, analysis and implementation of information systems in a health-care environment or analyzing public health data, HEDIS/QARR experience preferred.
  • Ability to travel within the MetroPlus service area when needed.
  • Position requires individual with high degree of accuracy. Must be able to translate theoretical knowledge into practical application.
  • Displays strong communication, interpersonal, and leadership ability across all levels coupled with effective problem solving, conceptual thinking, quantitative and analytical skills.
  • Strong written and verbal presentation as well as data analysis skills required.
  • Ability to work independently and multitask to meet deadlines.