Lead Clinical Analyst

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🕒 vor 13 Tagen

🐊 Florida – Remote

🐊 Florida – Remote

💵 $90.000 - $100.000 / Jahr

⏰ Vollzeit

🟠 Senior

🧐 Analyst

Jetzt Bewerben

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Health Network One

WebsiteLinkedInAlle Stellen

201 - 500 Mitarbeiter

Gegründet 1999

⚕️ Krankenversicherung

🤝 B2B

Healthcare Insurance • B2B

Health Network One ist ein Unternehmen für Gesundheitsnetzwerkmanagement, das mit Krankenversicherungen zusammenarbeitet, um spezialisierte ambulante Dienste (einschließlich ambulanter Therapie, routinemäßiger und medizinischer Augenpflege, Dermatologie und Fußpflege) unter Vollrisiko-Vereinbarungen zu verwalten. Das Unternehmen ist landesweit tätig, deckt über 7 Millionen Leben ab und arbeitet mit Zehntausenden von Anbietern zusammen. Es bietet delegierte Dienstleistungen wie Nutzungsmanagement, Akkreditierung, Schadens- und Netzwerkmanagement an. Health Network One legt Wert auf wertorientierte Lösungen, klinische Qualität, Kostensenkung für fachliche Ausgaben und Einrichtungsaufwand, und besitzt eine NCQA-Akkreditierung sowie eine HITRUST CSF Zertifizierung.

Beschreibung

• 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.

🎯 Anforderungen

• 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.