Director Data Operations

Highmark Health; Northern (KY); Hybrid; USD 129,000 - 215,000; Full time

Job summary

Highmark Health is seeking a senior data interoperability leader to drive the organization's healthcare data exchange strategy. You will bridge payer and provider ecosystems, oversee production data platforms, and ensure secure, reliable data access for internal and external stakeholders.

Responsibilities include guiding data integration using HL7/FHIR standards, mentoring teams, shaping technology strategy, and collaborating with IT partners to optimize operations and cost efficiency.

Qualifications

• Requires Bachelor’s Degree in Information Technology, Computer and Information Science, Computer Engineering, Health Informatics or related field; substitutions: 6 years of relevant work experience in lieu of a bachelor’s degree.
• 7+ years in Data Analytics preferred; 10+ years in healthcare interoperability and clinical data exchange; 15+ years in Healthcare IT delivery; 5+ years shaping and executing healthcare technology strategy.

Responsibilities

• Lead the strategic roadmap and execution for healthcare data exchange, bridging payer and provider technology ecosystems to improve clinical workflows and payer-provider alignment.
• Ensure robust data integration using HL7 V2 and FHIR to support population health initiatives and core health plan operations.
• Manage hiring decisions, coaching and development, rewards and recognition, performance management and staff productivity.
• Plan, organize, staff, direct and control day-to-day operations of the department; may have budgetary responsibility and authority.
• Monitor, maintain, and support production data platforms and analytics tools in collaboration with IT partners.
• Oversee a robust quality control process that tests and reviews all code and data processes for accuracy and reliability.
• Deliver all data assets in production on time to empower end-users.
• Act as liaison to data governance, data engineering teams, and external plan partners; support data access and troubleshooting.

Skills

Healthcare Interoperability

HL7

FHIR

APIs

Healthcare IT Strategy

Data Analytics

Payer & Provider Ecosystem

Education

Bachelor's Degree in IT/CS/Health Informatics or related field

Tools

Epic

Oracle

Job description

Company : enGen Job Description : JOB SUMMARY A critical focus of this role is driving the organization's healthcare interoperability strategy by championing seamless, bidirectional clinical and administrative data exchange between Highmark and its provider network. This flow of data is essential to optimizing core health plan operations, including case management, utilization management, risk programs, government quality programs, and claims processing. This job ensures the availability, performance and stability of processes that create, store and deliver data for internal and external stakeholders. To achieve this, the incumbent will lead teams that monitor, maintain and support an efficient and reliable production environment for all of Highmark Health’s analytic and operational data platforms. This includes reactive and proactive support for data engineering patterns that ingest, transform, and curate data; processes that create enriched datasets for use by data consumers; automation of key data product processes (e.g., ACGs, HEDIS); and access to and/or exchange of data through APIs and interoperable feeds. The incumbent will also manage effective and efficient quality control processes to ensure data are trustworthy and robust change control processes that balances our need to be nimble with the requirement of high quality and accuracy.

ESSENTIAL RESPONSIBILITIES

Lead the strategic roadmap and execution for healthcare data exchange, leveraging deep expertise in both payer and provider technology ecosystems (e.g., EHR/EMR platforms like Epic and Oracle) to bridge technical and operational gaps. Ensure robust data integration utilizing modern healthcare standards (e.g., HL7 V2, FHIR) to directly support and improve clinical workflows, population health initiatives, and payer-provider alignment. Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority. Monitor, maintain, and support the operational and analytic data platforms and technology, working closely with IT partners to ensure the group is leveraging the latest tools and technology. Oversee an efficient and effective quality control process that tests and reviews all code and processes to ensure accuracy. Create an overall production and continuous improvement discipline that not only delivers on quality, but continuously lowers our cost to deliver. Support data and analytic end-users and stakeholder needs for appropriate data access, awareness, understanding, and troubleshooting to ensure successful information delivery. Reliably deliver all assets that exist within the production environment (e.g., data sources, curated datasets, APIs, data feeds, analytic & business intelligence tools) on a timely and accurate basis such that end-users can be more efficient and effective in their job. Act as the liaison to the Organization's broader data governance processes, data engineering teams, and other key information technology partners. Act as a critical link to IT and our external plan partners who are leveraging our analytical tools. Other duties as assigned or requested.

EDUCATION

Required Bachelor's Degree in Information Technology, Computer and Information Science, Computer Engineering, Health Informatics or related field Substitutions 6 years of relevant work experience in lieu of a bachelor’s degree

EXPERIENCE

Required 7 years in Data Analytics Preferred 10+ years of dedicated experience in healthcare interoperability and clinical data exchange 15+ years in Healthcare IT delivery, requiring significant foundational experience on the provider side combined with strategic experience on the payer side 5+ years shaping and executing healthcare technology strategy

LICENSES AND CERTIFICATIONS

Required None Preferred None

SKILLS

Healthcare Interoperability (HL7, FHIR, APIs) Clinical Data Exchange & Integration Engines Healthcare IT Strategy & Delivery Payer & Provider Ecosystem Alignment Health Plan Operations (Utilization Management, Risk, Claims) EHR/EMR Platform Integration Healthcare Information Systems Health Information Management Talent Management IT Operations Language (Other than English) None

Travel Required 0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position type Office-Based Teaches / trains others regularly Frequently Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum: $129,100.00 Pay Range Maximum: $214,500.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users.

California Consumer Privacy Act Employees, Contractors, and Applicants Notice Highmark Health is a national, blended health organization that includes one of America’s largest Blue Cross Blue Shield insurers and a growing regional hospital and physician network. Based in Pittsburgh, Pa., Highmark Health’s 35,000 employees serve millions of customers nationwide through the nonprofit organization’s affiliated businesses, which include Highmark Inc., Allegheny Health Network, HM Insurance Group, United Concordia Dental, HM Health Solutions and HM Home & Community Services. Highmark Health’s businesses proudly serve a broad spectrum of health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions.