Business Analytics Senior Manager (Clinical Quality) - Evernorth Health Services - Remote

Job Profile Summary:

The Business Analytics Sr. Manager oversees a team of analytics professionals focused on clinical quality measurement and insights. Works in collaboration with business leaders and matrix partners to provide strategic partnership in analytics, identify and prioritize opportunities for impact, develop analytic solutions, leverage data science and technology capabilities, embed analytics-driven processes, and measure impact. Supports decision-making and execution based on data, facts, and analytical findings across the organization. Helps manage the development and execution of architecture, policies, practices, and procedures to support the information lifecycle needs of the organization.  Oversees the development and maintenance of dashboards and reporting for stakeholders to monitor clinical quality results.

Position Summary:

This role leads strategic and operational efforts within the Clinical Quality Data & Informatics (CQDI) team to improve population health outcomes through data-driven clinical initiatives. The Business Analytics Senior Manager is responsible for managing complex projects, transforming traditional Healthcare Effectiveness Data and Information Set (HEDIS) measurement/reporting into digitally acquired analytics, and generating insights that support clinical strategy and regulatory compliance. The role requires agility to pivot with industry shifts and a commitment to improving clinical performance rates through collaborative, insight-driven action.  The Sr. Manager will bring in a continuous improvement perspective to identify data automation opportunities, improve data quality/accuracy, and curate actionable insights.  The Sr. Manager must understand how to create datasets, perform statistical analysis, develop business cases, and present findings to senior leaders.

Responsibilities:

Strategic Leadership & Business Analytics

• Lead and manage clinical quality analytics projects from conception through execution
• Set departmental goals aligned with functional strategy and business priorities
• Act as a liaison between IT development and business units to implement new systems and data solutions
• Demonstrate agility to pivot with industry changes, including digital quality transformation
• Set a high bar for analytical rigor and effective communication
• Recommends and initiates new analytical or technical skillset changes as deemed necessary to achieve strategic vision

Data Management & Insight Development

• Extract and analyze data from eligibility, claims, pharmacy, lab, race/ethnicity, and 3rd party sources
• Create dashboards and visualizations to present insights that support strategic decision-making
• Perform statistical and qualitative analysis to evaluate internal/external quality initiatives
• Develop queries and reports to identify non-compliant populations for outreach across commercial and IFP markets
• Influence data acquisition and centralization roadmap based on analytical needs

HEDIS & Regulatory Reporting

• Lead HEDIS data collection, hybrid review, and reporting
• Interface with external partners and state immunization registries for data submission
• Analyze market-specific HEDIS measures against NCQA, Cigna national/regional benchmarks, and competitor data
• Generates insights and defines clear opportunities for improvement
• Identify automation and process improvement areas to create bandwidth for more proactive initiatives

Collaboration & Matrix Engagement

• Partner with matrix and external teams to drive personalization and localization of clinical initiatives
• Use shared collective input from matrix partners to inform strategies and improve overall performance rates
• Enable clinical initiatives teams to interact with data and generate actionable insights
• Provide consultation and input into clinical initiatives through data and business case support

Operational Efficiency & Process Improvement

• Design and maintain tools to track, trend, and forecast HEDIS EOC performance
• Improve chase report accuracy and reduce provider abrasion through data refinement
• Maintain the Quality SharePoint site and document analytic methodologies for cross-training
• Identify legacy reporting processes that can be retired or automated

Compliance & Accreditation Support

• Define and consult on measurement strategies and tools to support NCQA accreditation and state regulatory requirements
• Ensure data integrity and quality in all reporting and analysis efforts
• Identify business opportunities and areas for improvement through performance monitoring

Leaders