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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 metrics specific to vendors 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, finance 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 optimize vended programs and products to maximize revenue growth. Utilizes advanced 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.

• 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, and Medicaid 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 ad hoc data request and 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

• Travel may be up to 25%

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree

• 5+ years of data analytics 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 & Saas

• 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

Role Desirables

• Databricks and/or Snowflake experience

• Experience with data management and analytics tools such as Python & PySpark

• 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 healthcare authorization data and claims data

• Experience mapping disparate sources of data, and creating relational data models and databases

Additional Information

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humana’s secure website.

 

 

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.

 

$97,900 - $133,500 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.