Senior Data Analyst, Clinical Programs

This is a fully remote position, open to applicants in Texas.

📋 Description

• Oversee Utilization Management and Case Management operations by establishing KPIs and benchmarks (e.g., member engagement rates, readmission rates, preventable hospitalizations, emergency room usage).

• Create statistical models that provide valuable insights into costs, utilization, and clinical outcomes derived from various data sources.

• Formulate algorithms for segmenting populations and identifying high-risk members.

• Utilize Predictive Analytics to evaluate the performance (ROI) of Disease Management and other Medical Management programs.

• Conduct prospective savings assessments to support clinical program initiatives.

• Develop and maintain client-oriented reports, dashboards, and analyses.

• Generate actionable data insights and provide strategic recommendations to clients.

• Engage in program performance review presentations alongside clinical program managers, client account managers, and external clients, as necessary.

• Manage requests and timelines from both internal and external clients to ensure prompt delivery.

• Collaborate with the Medical Management team to provide continuous support.

⛳️ Requirements

• A Bachelor's degree is required, preferably in Mathematics, Statistics, Finance, Actuarial Science, Data Science, or a related discipline.

• 5-7 years of experience in healthcare analytics, ideally within a managed care environment.

• Required proficiency in SQL and the Microsoft SQL Server Suite of Products (SSMS).

• Required proficiency in MS Excel.

• Advanced skills in data analysis, financial modeling, and predictive analytics.

• Experience in clinical program evaluation and outcomes reporting.

• Familiarity with health plan performance reporting and cost and utilization analysis.

• Experience in creating client-facing reports.

• Experience with Business Intelligence tools and DAX functions (PowerPivot, Power BI, Tableau).

• Ability to articulate technical concepts to a non-technical audience.

• Capability to effectively manage and prioritize multiple concurrent projects.

• Excellent verbal and written communication skills.

• Experience with Payer Care Management platforms (e.g., ZeOmega) is a plus.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible work hours

• Paid time off