Operating Effectiveness Senior Analyst - EviCore - Remote
Core
Design, implement, and optimize clinical decision-support pathways, business rules, algorithms, and automated workflows to enable scalable utilization management programs.
Role type
Senior IC business systems analyst (clinical operations)
Builds
Automated decision-support solutions, workflow configurations, and operational processes for utilization management
Domain
Healthcare operations / Utilization management / Clinical decision support
Deliverable
production ML models | product features
Required skills
Workflow design, business rules configuration, process improvement, data analysis, root cause analysis, system testing, regulatory compliance (HIPAA/NCQA/URAC)
Preferred skills
Business rules engines, Visio, SharePoint, Tableau, SQL, Databricks, AI-enabled solutions, intelligent workflow platforms
Responsibilities
Design and optimize clinical decision-support pathways; Translate clinical guidelines into system logic; Partner with stakeholders to identify automation opportunities; Resolve operational issues using data analysis; Conduct functional and quality assurance testing; Monitor system performance and operational metrics
Seniority
Senior, hands-on IC
