Medical Informatics Analyst, Consultant

Your Role

The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Medical Informatics, Consultant will report to the Manager of HQA Analytics. In this role you will be responsible for evaluating the financial performance and impact of clinical initiatives within the Medical Care Programs team. This role focuses on analyzing healthcare cost drivers, quantifying savings and outcomes generated by clinical interventions, and providing actionable insights to support cost containment and quality improvement strategies.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience

• Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent

• Requires at least 7 years of prior relevant experience

• Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer)

• Requires proficiency in one or more dashboard/BI tools, such as Power BI or Tableau

• Requires at least 3 years of data modeling experience, and advanced proficiency in SQL for complex query development, data transformation, and performance optimization across large-scale datasets

• Demonstrated financial acumen with a deep understanding of healthcare cost structures, including but not limited to drivers of medical expense such as utilization, unit cost, site of care, and member risk profile. Ability to interpret and analyze cost trends across medical and pharmacy spend and evaluate the financial impact of clinical and operational initiatives to support informed decision-making and cost containment strategies

• Experience evaluating and calculating return on investment for clinical program participation, including measuring program costs against realized savings and outcomes to assess financial effectiveness and value highly preferred

• Experience working with authorization datasets and medical policies, with strong familiarity in analyzing medical and pharmacy services, including interpretation and application of CPT, HCPCS, ICD, and NDC procedure/code sets, is a plus

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.