Sr. Manager, Medical Informatics - Utilization Management Analytics

HITEC; Long Beach (CA); Hybride; USD 150 000 - 190 000; Plein temps

Résumé du poste

HITEC in California is seeking a Senior Manager, Medical Informatics - Utilization Management Analytics to lead a team responsible for Prior Authorization, Concurrent Review, and broader UM analytics. You will translate clinical priorities into actionable analytical strategies and drive improvements across lines of business.

You will develop capabilities, inform executive decisions, and foster growth in a hybrid workplace, with in-office collaboration two days a week and flexible scheduling to

Qualifications

• Bachelor's degree or HS diploma with 4 years of additional relevant experience; graduate degree preferred.
• 8 years of prior relevant experience in a medical informatics position.
• 4 years of prior people management experience with supervising and coaching.
• Knowledge of data exchange regulations applicable to California health insurance.
• Understanding of UM concepts and performance measures (authorization volume, approval/denial rates, timeliness).
• Strong knowledge of healthcare payer operations; experience supporting UM analytics.
• Four years of experience analyzing California payer/provider data.
• Two years of HIPAA and California health data privacy experience.

Connaissances

Leadership

Healthcare analytics

Data analysis

HIPAA knowledge

CA privacy rules

Prior Authorization

Team management

UM analytics

Formation

Bachelor's degree or higher

MPH

MBA

MS

MA

RN

RHIA

Description du poste

Your Role

The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Sr. Manager, Medical Informatics - Utilization Management (UM) Analytics will report to the Director of HQA Analytics and lead a team responsible for Prior Authorization, Concurrent Review, and broader UM analytics. This leader will translate clinical and operational priorities into actionable analytical strategies, strengthen organizational understanding of utilization and authorization performance, develop team capabilities, and deliver insights that inform operational improvement, executive decision-making, affordability, quality, and member outcomes across lines of business.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree. A Graduate degree (MPH, MBA, MS, MA, RN, or RHIA) in a relevant field and 2 years of post-degree healthcare analytics experience is preferred
• Requires 8 years of prior relevant experience in a medical informatics position within the healthcare industry
• Requires 4 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
• Command of legal and regulatory issues that apply to data exchange, processing, and analysis in the California health insurance industry
• Demonstrated understanding of key UM concepts and performance measures, including authorization volume, approval and denial rates, decision timeliness, inpatient admissions, length of stay, avoidable days, levels of care, readmissions, and authorization-to-claims reconciliation
• Strong knowledge of healthcare payer operations, with direct analytical experience supporting UM, Prior Authorization, Concurrent Review, or related clinical functions is strongly preferred
• Four (4) years of experience analyzing California payer/provider data and interpreting utilization, cost, and outcomes measures is preferred
• Two (2) years of experience applying HIPAA and California health data privacy requirements to data exchange, processing, and analysis is preferred
  

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.