Lead, Medical Informatics & UM Analytics (Hybrid)

Blue Shield of CA; Springfield Meadows (CA); Hybride; USD 140 000 - 180 000; Plein temps

Résumé du poste

Blue Shield of CA is seeking a Sr. Manager, Medical Informatics - Utilization Management Analytics to lead a team focused on Prior Authorization and Concurrent Review analytics.

The role translates clinical priorities into data-driven strategies to improve affordability, quality, and member outcomes across lines of business. The position requires extensive healthcare analytics experience, leadership and regulatory knowledge, and a strong grasp of California payer data.

Qualifications

• Requires a Bachelor's degree or higher and 4 years of additional relevant experience in lieu of a degree; graduate degree preferred for advanced analytics.
• Requires 8 years of prior relevant experience in a medical informatics position within healthcare.
• Requires 4 years of people management experience with direct supervision responsibilities.
• Knowledge of legal and regulatory issues for data exchange in California health insurance.
• Strong understanding of UM concepts and performance measures (authorization, timeliness, cost, outcomes).
• Experience with California payer operations and data analysis preferred.

Responsabilités

• Lead a team responsible for Prior Authorization, Concurrent Review, and broader UM analytics.
• Translate clinical and operational priorities into actionable analytics strategies.
• Deliver insights to inform operational improvement, executive decisions, affordability, and member outcomes.
• Foster continuous learning and leadership development within the team.

Connaissances

Healthcare analytics

People management

Regulatory compliance

HIPAA privacy

UM concepts

California payer data

Formation

Bachelor's degree or higher

Graduate degree (MPH, MBA, MS, MA, RN, RHIA)

Description du poste

Blue Shield of CA is seeking a Sr. Manager, Medical Informatics - Utilization Management Analytics to lead a team focused on Prior Authorization and Concurrent Review analytics.

The role translates clinical priorities into data-driven strategies to improve affordability, quality, and member outcomes across lines of business. The position requires extensive healthcare analytics experience, leadership and regulatory knowledge, and a strong grasp of California payer data.