Care Pathway & Patient Engagement Analyst

Blue Cross and Blue Shield of North Carolina; Philadelphia (Philadelphia County); Ibrido; USD 89.000 - 143.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental and vision coverage

Parental leave and surrogacy support

Tuition reimbursement and career dev

401k match and PTO

Descrizione del lavoro

Blue Cross NC seeks a Care Pathway & Patient Engagement Analyst to advance affordability and patient outcomes through analytics, engagement insights, and care pathway optimization. You will partner across Utilization Management, Care Management, Network, Pharmacy, Actuarial, Finance, Technology, and Clinical teams to design and implement key affordability initiatives.

The ideal candidate is highly analytical, execution-focused, and adept at translating data into actionable recommendations.

Competenze

• Bachelor's degree or advanced degree is required or equivalent experience.
• 5+ years of experience in a related field.

Mansioni

• Conduct claims and other analyses focusing on care pathways, patient engagement, utilization patterns, provider performance, affordability opportunities, and consumer behavior.
• Support development of analytic frameworks to identify where members benefit from interventions.
• Develop predictive models, segmentation, and targeting for member outreach and engagement strategies.
• Execute analyses with rigorous measurement methods including A/B tests and quasi-experimental approaches.
• Analyze longitudinal healthcare journeys to identify utilization patterns and care gaps.
• Apply episode-of-care methodologies and care pathway analytics to understand drivers of cost and quality.
• Support financial-impact measurement with actuarial and finance teams to quantify opportunities and savings.
• Build analyses incorporating patient risk, social determinants of health, and engagement propensity.
• Leverage provider, network, and site-of-care analytics to identify improvement opportunities.
• Apply geospatial analytics to understand provider availability and access.
• Collaborate with tech and data teams to develop integrated data assets.
• Develop dashboards and decision-support tools for affordability teams.
• Explore AI/ML and NLP applications to improve pathway analytics and engagement.
• Translate findings into clear recommendations for leaders and stakeholders.
• Contribute to a high-performing team culture with rigorous analytics and impact.

Conoscenze

Healthcare analytics

SQL

Python

R

Data visualization

BI platforms

Cloud analytics

Statistical analyses

Analytical modeling

Formazione

Bachelor's degree or advanced degree

Strumenti

Python

R

Excel

BI tools

Descrizione del lavoro

Job Description

We are seeking a Care Pathway & Patient Engagement Analyst to serve Curacor Solutions' (CCS) Affordability function in advancing the organization's "right care, right time, right place" strategy through innovative analytics, consumer engagement insights, and care pathway optimization. Working closely with leadership, this individual will help develop analytic solutions that improve affordability, enhance patient engagement, and strengthen healthcare outcomes. This role is ideal for a highly analytical, intellectually curious, and execution-oriented professional who enjoys solving complex problems and translating data into actionable recommendations. The successful candidate will partner across Utilization Management, Care Management, Network, Pharmacy, Actuarial, Finance, Technology, and Clinical teams and will contribute to the design, execution, and implementation of key affordability initiatives.

What You'll Do

• Conduct claims and other analyses focused on care pathways, patient engagement, utilization patterns, provider performance, affordability opportunities, and healthcare consumer behavior.
• Support the development of analytic frameworks that identify where members are most likely to benefit from interventions, including opportunities to improve care quality, increase engagement, reduce unnecessary utilization, and optimize site-of-care decisions.
• Develop predictive models, segmentation approaches, and targeting methodologies that support member outreach, affordability initiatives, care navigation programs, and engagement strategies.
• Execute analyses that evaluate engagement strategies, outreach programs, and affordability initiatives using rigorous measurement approaches, including A/B testing, quasi-experimental methods, and other impact evaluation techniques.
• Analyze longitudinal healthcare journeys to identify utilization patterns, care gaps, clinical variation, and opportunities for intervention.
• Apply episode-of-care methodologies, pathway analytics, and healthcare grouping approaches to understand drivers of medical cost, utilization, quality, and patient experience.
• Support financial-impact measurement efforts by partnering with actuarial, finance, and affordability teams to quantify opportunities, intervention impact, and realized savings.
• Build analyses that incorporate patient risk, disease burden, social determinants of health, clinical complexity, benefit design, and engagement propensity to better understand member behavior and intervention opportunities.
• Leverage provider, network, referral, access, and site-of-care analytics to identify opportunities for network strategy, provider enablement, and member navigation improvements.
• Apply geospatial analytics to understand how provider availability, travel burden, appointment access, and network characteristics influence healthcare utilization and consumer decision-making.
• Partner with technology and data teams to support the development of integrated healthcare data assets spanning claims, pharmacy, EHR, provider, member, care management, and operational data sources.
• Develop dashboards, reports, decision-support tools, and analytical products that enable affordability teams to identify and act on emerging opportunities.
• Explore practical applications of AI, machine learning, natural language processing, and generative AI to improve pathway analytics, patient engagement, prioritization, and decision support.
• Translate analytical findings into clear, concise recommendations and presentations for business leaders and operational stakeholders.
• Contribute to a high-performing team culture by sharing knowledge, supporting colleagues, and maintaining high standards for analytical rigor and business impact.

What You Bring

• Bachelor's degree or advanced degree (where required)
• 5+ years of experience in related field.
• In lieu of degree, 7+ years of experience in related field.

Bonus Points

• Experience in healthcare analytics, health plan analytics, healthcare data science, clinical informatics, health economics, management consulting, actuarial analytics, or a related quantitative discipline.
• Experience working with healthcare data, including medical and pharmacy claims, provider data, eligibility data, care management data, or related healthcare datasets.
• Proficiency in SQL and familiarity with modern analytics tools such as Python, R, or comparable analytical technologies.
• Experience conducting statistical analyses, developing analytical models, and working with large healthcare datasets.Experience developing analyses, dashboards, reports, or decision-support tools that support operational decision-making and business strategy.
• Familiarity with episode-based analytics, care pathway analyses, clinical grouping methodologies, or healthcare journey analytics is preferred.
• Experience using modern business intelligence platforms, cloud-based analytics environments, and data visualization tools.

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.
• Work-life balance, flexibility, and the autonomy to do great work.
• Medical, dental, and vision coverage along with numerous health and wellness programs.
• Parental leave and support plus adoption and surrogacy assistance.
• Career development programs and tuition reimbursement for continued education.

• 401k match including an annual company contribution.

Where You'll Work

Our Hybrid Flex approach is built on presence with a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplace that's flexible, connected, and future focused.

In a Hybrid-Flex role, you'll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you'll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any state listed on this job posting. Onsite expectations will be discussed during the interview process.

About CuraCor Solutions

Blue Cross NC is part of CuraCor Solutions, a larger health care organization that brings together Blue Cross NC, our Corporate Center teams, and other health care businesses and affiliates - all connected by a shared purpose of making health care better for all. To learn more, visit curacor.com.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$89,174.00 - $142,679.00

Skills

Healthcare Consulting, Healthcare Financial Management, Healthcare Industry, Healthcare Innovation, Healthcare Management, Healthcare Reimbursement, Healthcare Strategic Planning, Health Outcomes, Medical Reimbursement, Performance Metrics, Physician Reimbursement, Project Management, Provider Reimbursement, Reimbursement, Reporting and Analysis