Become a part of our caring community and help us put health first
 

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.

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

Use your skills to make an impact
 

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

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$86,600 – $119,200 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.