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Description

The Clinical Vendor Oversight Senior Informaticist supports the development and implementation of reporting and metrics that influence providers, members, market partners, and utilization management vendors. The work will require the ability to integrate data from multiple sources to produce the requested/required data elements needed for vendor reporting and analysis. Supports routine vendor metrics and dashboard reviews to help identify potential process gaps and performance trends. Applies disciplined analytics to optimize vendor programs to maximize revenue growth. Coordinates with other analytics, IT, and business areas across the organization to ensure work is completed with insights from knowledge SMEs. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

The Clinical Vendor Oversight Senior Informaticist leverages advanced knowledge of data, modeling, optimization, and tools. Applies disciplined analytics to predict behavior and optimize programs and products to maximize revenue growth. Utilizes advanced or predictive modeling to develop, test and validate cases that improve the outcomes and quality of the programs we offer. Contributes to more innovative approaches to financial models, while building knowledge of the business. Understands and analyzes complex data, articulates to various units within the company at the appropriate level, impacts the business from mathematical concepts which have a potentially sizeable dollar impact on the business. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

In this role you will:

  • Develop and establish strong and effective working relationships with Clinical Vendor Management Professionals, leadership, and external clinical vendors who aid in managing medical utilization for Medicare, Medicaid, and Commercial lines of business.
  • Master the intricacies of the data fields
  • Obtain, validate, and analyze data from internal and external raw sources and finished reports, anticipating the needs of report end users
  • Support the design, development, maintenance, and delivery of operational reports, dashboards, and ad hoc requests
  • Continually identify ways to improve and enhance current reports, increasing value and usability
  • Collect and document business requirements for reporting and analysis initiatives.
  • Support research necessary to fully understand and correctly utilize the required clinical data
  • Aid in deriving observations and insights from metrics to support and improve clinical operations

Required Qualifications

  • Bachelor's degree and 5+ years of data analytics experience OR Master's degree and 3 years of experience
  • 3+ years of experience with data mining, trend identification, and using data to drive business outcomes, recommendations, actionable insights, and decisions
  • Experience with data management and analytics tools such as SQL, SAS, or Azure Synapse Analytics
  • Experience with business intelligence and visualization tools such as Power BI or Tableau and Excel
  • Demonstrated ability in verbal and written communication to articulate and present data findings and insights to all levels, including senior leadership
  • Strong attention to detail
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

  • Experience applying Lean and Six Sigma principles and methodologies to drive process efficiency and quality
  • Experience using automation tools, like MS Power Automate, to create process efficiencies
  • Experience with predictive modeling
  • Experience with healthcare authorization data and claims data, and interoperability standards like FHIR
  • Experience mapping disparate sources of data, and creating relational data models and databases

Scheduled Weekly Hours

40



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Our Hiring Process

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Next Step

If selected to continue with the interview process, you will be contacted through text or email to complete an assessment or schedule an initial live or recorded phone or video interview.

A hiring manager interview

After hiring managers and interview teams carefully consider the skills and experiences of applicants, they contact the top candidates via email or phone to schedule an interview.

Offer from Humana

If you’ve successfully completed the interview process and are identified as the candidate we would like to hire, you will receive an offer from our Talent Acquisition team.

Onboarding

If you accept the offer to join our Humana team, you will receive a welcome call or email to begin the onboarding process.


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Hiring Process