Clinical Analytics Analyst III: Data-Driven Healthcare

Florida Blue; Florida; Hybrid; USD 60,000 - 97,000; Full time

Job summary

Florida Blue is seeking an Analyst to work on data-driven decisions within a hybrid environment. You will research, analyze, and manage data used for forecasting, planning, and risk assessment, collaborating with UM leadership and stakeholders.

The role emphasizes understanding healthcare regulations (CMS, NCQA), utilization management processes, and clinical data systems, with opportunities for professional growth and comprehensive benefits.

Qualifications

• 3+ years related work experience.
• Related Bachelor's degree or additional related equivalent work experience
• Demonstrates understanding of healthcare regulations (e.g. CMS, NCQA)
• Knowledge of utilization management processes, prior authorization workflows, and regulatory reporting standards
• CMS-0057F Prior Auth Metrics
• NCQA Reporting & Preparation
• Familiarity with quality metrics and value-based care initiatives
• Experience with data analytics tools and visualization software
• Ability to learn and adapt to new healthcare technologies and software applications
• Serves as a clinical data resource expert and trusted advisor to UM leadership and stakeholders
• Educates interdisciplinary teams on clinical data reporting, information extraction, and system workflows
• Translates clinical needs into technical solutions
• Healthcare domain expertise and understanding of clinical work and processes
• Ability to combine clinical knowledge and analytical skills to bridge communication between technical teams and clinical stakeholders

Responsibilities

• Research, analyze, maintain, modify, validate and prepare data, information and content used in making business decisions. Output is used for forecasting, costing, planning, positioning, trending, measuring, controlling risk, contracting and administration. Present findings and articulate results
• Monitor, maintain and test the Company's systems that manage business and work processes
• Monitor and evaluate the effectiveness of solutions, policies, practices and processes to ensure continuous improvement, good client relations, compliance and adherence to business and system requirements. Recommend improvements to achieve and deliver high quality, value-added services
• Produce, edit and distribute a variety of business documents such as reports, system and process documentation, etc.
• Create, present and/or facilitate meetings, webinars, conference calls, training programs, education sessions, certifications, etc. for primarily internal audiences
• Participate on or lead smaller departmental projects or components of projects. May plan, organize, monitor and control projects to ensure the effective use of resources and adherence to project management standards and reporting requirements
• Participate on and/or lead department/divisional workgroups and initiatives
• Develop and build internal partnerships to improve communication, coordination, collaboration and effective working relationships within own department

Skills

Analytical skills

Healthcare domain knowledge

Communication

Adaptability

Education

Bachelor's degree or related equivalent work experience

Tools

Clinical systems (UM Prior Authorizations, Grievance & Appeals, Care Management, EMR)

Data analytics tools

Visualization software

Job description

Florida Blue is seeking an Analyst to work on data-driven decisions within a hybrid environment. You will research, analyze, and manage data used for forecasting, planning, and risk assessment, collaborating with UM leadership and stakeholders.

The role emphasizes understanding healthcare regulations (CMS, NCQA), utilization management processes, and clinical data systems, with opportunities for professional growth and comprehensive benefits.