Director, Clinical Analytics - Emory Health Plan

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Description

Director of Clinical Analytics Emory Health Plan (EHP) serves as the analytical bridge between clinical performance and financial outcomes for a large, self-funded health plan serving tens of thousands of members.

 

KEY RESPONSIBILITIES:

• Owns EHP's population health analytics function, leads clinical quality performance measurement, drives vendor ROI assessment, and supports the financial case for care management and benefits design investments.
• Presents data that informs how EHP bends medical and pharmaceutical trends and how leadership makes the highest-stakes financial decisions the plan faces.
• Owns member population cost stratification, emerging high-cost member identification, and longitudinal cost trajectory analysis.
• Maps high-cost populations to diagnosis, care setting, and care management gaps.
• Identifies highest-yield opportunities to bend medical trend through care management gaps, avoidable utilization, site-of-care substitution, and specialty drug management, and produces prioritized opportunity matrices with estimated savings ranges and implementation complexity for executive decision-making.
• Owns quality measure analytics for EHP, including measure calculation, compliance reporting, gap analysis, and performance trend across relevant quality domains.
• Quality performance is translated into financial terms, quantifying the implications of quality gaps and improvements under value-based arrangements.
• Applies external benchmarking methodology to identify where EHP's clinical performance and cost differ from peers, tracks quality gate performance and utilization benchmarks under all value-based arrangements and owns the clinical outcomes assessment layer of all vendor ROI scorecards.
• Co-owns the clinical outcomes and utilization components of all vendor ROI scorecards and value-based arrangements, including quality gates, utilization benchmarks, and savings calculations.
• Partners with Finance and Actuarial to reconcile clinical performance against contractual guarantees and shared savings.
• Assesses wellness platform and point solution vendors (including Maven, Hinge, and Flyte) with the same evidence standards applied to provider quality performance, supports value-based contract performance monitoring, and delivers ROI analysis on care management programs with measurable, Arcadia-grounded outcomes.
• In partnership with the AVP Finance EHP, provides clinical and utilization analytics inputs to benefits design financial modeling, supports MLR decomposition and trend attribution by cohort, condition, site of care, and benefit design, and provides IBNR and reserve analyses with clinical and utilization context.
• Supports stop-loss strategy by characterizing high-cost claimants and catastrophic cost patterns by diagnosis, care setting, and persistence.
• Serves as the finance function's analytical partner to clinical operations, pharmacy, and care management leadership.
• Co-owns pharmacy analytics with the Director of Health Plan Informatics, including class of trade, specialty and biosimilar management, formulary and tiering performance, adherence analytics, and point solution impact.
• Embeds PBM SLA and guarantee analytics and rebate/utilization reconciliation as standing responsibilities.
• Defines and maintains clinical analytics methodologies, including risk stratification logic, member attribution, and avoidable utilization definitions, in formal collaboration with the Director of Health Plan Informatics to prevent dueling definitions across teams.
• Owns documentation of all clinical logic embedded in dashboards and reports to support auditability and organizational continuity.
• Leads and supervises analytical staff, providing mentoring in the areas of clinical analytics, quality measurement, population health, and crafting a financial story for leadership.
• Provides training and guidance to direct reports and ensures that their skills are developed to add value to the team and create a clear path for advancement and success within the organization.
• Performs related responsibilities as required. 

MINIMUM QUALIFICATIONS:

• Bachelor's degree in clinical informatics, public health, health administration, statistics, economics, or a quantitative or life sciences discipline required; Master's degree in public health, health informatics, or healthcare administration preferred.
• 7+ years of progressive experience in clinical analytics