Senior Manager, Medical Informatics - UM Analytics

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 150,000 - 210,000; Full time

Job summary

Blue Shield of CA is seeking a Sr. Manager, Medical Informatics - Utilization Management Analytics in California.

The role leads a team focused on Prior Authorization, Concurrent Review, and broader UM analytics, translating clinical priorities into actionable strategies and driving insights to improve affordability, quality, and member outcomes. The leader will strengthen organizational understanding of utilization and authorization performance, develop capabilities, and partner with

Qualifications

• Requires a Bachelor's degree or High School Diploma/GED with 4 years of additional relevant experience in lieu of a degree.
• 8 years of prior relevant experience in a medical informatics position in healthcare.
• 4 years of people management experience with direct supervision responsibilities.
• Knowledge of legal and regulatory issues for data exchange in the CA health insurance industry.
• Understanding of UM concepts and performance measures (authorization volume, denial rates, timeliness, readmissions, etc.).
• Experience supporting UM, Prior Authorization, Concurrent Review or related clinical functions.
• Experience analyzing CA payer/provider data and interpreting utilization, cost and outcomes measures.
• Experience applying HIPAA and California health data privacy requirements.

Responsibilities

• Lead a team responsible for Prior Authorization and Concurrent Review analytics.
• Translate clinical and operational priorities into actionable analytical strategies.
• Develop team capabilities and deliver insights for operational improvement and executive decision-making.
• Collaborate with payer operations to inform affordability and member outcomes across lines of business.

Skills

Medical informatics

Healthcare analytics

Leadership

HIPAA compliance

Payer analytics

Education

Bachelor's degree or HS diploma

Graduate degree preferred

Job description

Blue Shield of CA is seeking a Sr. Manager, Medical Informatics - Utilization Management Analytics in California.

The role leads a team focused on Prior Authorization, Concurrent Review, and broader UM analytics, translating clinical priorities into actionable strategies and driving insights to improve affordability, quality, and member outcomes. The leader will strengthen organizational understanding of utilization and authorization performance, develop capabilities, and partner with