Operating Effectiveness Senior Analyst - EviCore
Core
Design and optimize clinical decision-support pathways, business rules, algorithms, and automated workflows to improve healthcare program operations at scale.
Role type
Senior IC operating effectiveness analyst (healthcare operations)
Builds
Automated decision-support solutions, clinical workflows, and utilization management systems
Domain
Healthcare operations and utilization management
Deliverable
production ML models | product features
Required skills
Clinical decision support, workflow design, business rules engines, data analysis, root cause analysis, regulatory compliance (HIPAA, NCQA, URAC), system testing, change management
Preferred skills
AI-enabled solutions, intelligent workflow platforms, Tableau, SQL, Databricks, Visio, SharePoint
Responsibilities
Design and maintain clinical decision-support pathways and automated workflows; Translate clinical guidelines and business requirements into system logic; Partner with cross-functional teams to identify automation and AI integration opportunities; Apply data analysis to resolve operational challenges; Conduct functional, regression, and quality assurance testing; Monitor system performance and optimize workflows; Create process documentation and training materials; Support program implementations and enterprise initiatives; Ensure compliance with regulatory and quality standards; Use reporting and analytics to generate insights and reduce manual effort.
