Lead Clinical Analyst

Vaga não está no LinkedIn

🕒 Junho 2

🐊 Florida – Remoto

🐊 Florida – Remote

💵 $90.000 - $100.000 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

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Health Network One

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 1999

⚕️ Seguro de Saúde

🤝 B2B

Healthcare Insurance • B2B

A Health Network One é uma empresa de gestão de redes de assistência médica que faz parcerias com planos de saúde para gerenciar serviços ambulatoriais especializados (incluindo terapia ambulatorial, cuidados oftalmológicos de rotina e médicos, dermatologia e podologia) sob acordos de risco total. A empresa opera nacionalmente, cobrindo mais de 7 milhões de vidas e contratando com dezenas de milhares de prestadores, oferecendo serviços delegados como gestão de utilização, credenciamento, gerenciamento de reivindicações e de rede. A Health Network One enfatiza soluções baseadas em valor, qualidade clínica, redução de custos para gastos profissionais e de instalações, e possui acreditação da NCQA e certificação HITRUST CSF.

Descrição

• Lead the design, development, and optimization of enterprise clinical performance dashboards (e.g., utilization, care management effectiveness, access metrics, and quality performance). • Development of recurring and adhoc analytics using SQL, Excel, and Power BI. • Translate complex clinical datasets into strategic recommendations for executive leadership, operational teams, and quality stakeholders. • Establish data validation standards and ensure accuracy, completeness, and integrity across reporting environments. • Serve as a senior subject-matter expert for clinical analytics methodologies, performance measurement, and reporting best practices. • Partner with clinical and operational leadership to define KPIs aligned with enterprise performance goals. • Lead cross-functional collaboration with IT, data engineering, operations, and quality teams to improve data architecture and reporting accessibility. • Present insights and narratives to senior stakeholders in clear, decision-ready formats. • Guide prioritization of analytics initiatives supporting organizational strategy and regulatory requirements. • Mentor junior analysts and strengthen analytics capabilities across teams. • Partner with Compliance and clinical stakeholders to support state, federal and health plan reporting requirements, including NCQA, CMS, JOC. • Development of performance metrics used in audits, accreditation readiness, and compliance monitoring. • Support enterprise readiness for regulatory reviews through proactive analytics monitoring and documentation. • Drive automation of manual reporting workflows and implementation of scalable reporting solutions. • Establish documentation standards, reporting governance processes, and analytics best practices. • Lead initiatives to modernize clinical reporting infrastructure and improve enterprise data usability. • Identify opportunities to leverage analytics for performance optimization and cost-of-care improvement.

🎯 Requisitos

• Bachelor’s degree (or equivalent experience) in public health, data analytics, health informatics, business, or a related field. • 5+ years of experience with advanced proficiency in SQL, Excel, and Power BI • 3+ years of experience working with healthcare datasets, including claims, utilization management/prior authorization, care management, and quality measures. • Strong understanding of clinical workflows, utilization and network management analytics, and healthcare economics. • Demonstrated ability to translate complex analytics into executive-level insights and operational recommendations. • Excellent stakeholder engagement, communication, and strategic problem-solving skills. • Self-starter with the ability to manage multiple priorities independently.