AVP, Data & Analytics - Clinical informatics/Risk and Quality
Accountabilities: Lead the enterprise payer analytics strategy across Medicare, Medicaid, Marketplace, Dual, and Commercial populations, with a focus on quality, risk adjustment, clinical outcomes, operational performance, and business results.
Oversee enterprise reporting and business intelligence capabilities, ensuring delivery of trusted KPIs, dashboards, reporting solutions, and self-service analytics for strategic and operational decision-making.
Direct Quality, Risk Adjustment, and Clinical Analytics programs, including HEDIS®, Star Ratings, RAF performance, population health, care management, utilization management, and provider performance analytics.
Develop and execute analytics strategies that translate complex clinical, operational, and financial data into actionable recommendations for senior leadership.
Identify opportunities to apply artificial intelligence, machine learning, predictive analytics, and automation to improve decision support and accelerate measurable business value.
Lead the implementation of AI/ML-augmented analytical solutions across the payer environment, ensuring alignment with business priorities and practical operational needs.
Partner with data, technology, clinical, and business leaders to ensure analytics solutions are supported by reliable data, scalable technology platforms, and effective governance.
Establish and strengthen data and analytics governance practices to promote data quality, consistency, transparency, and trusted enterprise reporting.
Develop analytics capabilities that support improved member outcomes, financial performance, quality scores, risk management, and organizational growth.
Build, mentor, and lead high-performing analytics teams, fostering accountability, innovation, collaboration, and continuous professional development.
Establish strong cross-functional partnerships and communicate complex analytical findings in a clear, concise, and actionable manner to executive and operational stakeholders.
Continuously evaluate analytics capabilities, emerging technologies, and market developments to identify opportunities for greater efficiency, insight, and competitive advantage.
Requirements:
Bachelor’s degree in business administration or a related field is required; a Master’s degree in Business Administration or a related discipline is preferred.
10+ years of operational experience, with a demonstrated record of increasing responsibility in data, analytics, healthcare operations, or related environments.
At least 5 years of supervisory or management experience within managed care, Medicare, or a closely related healthcare environment.
5+ years of hands-on experience with SQL, programming, relational databases, and financial analysis.
At least 3 years of experience implementing AI- and machine-learning-augmented analytics solutions within the payer or healthcare landscape.
Strong knowledge of payer analytics, including quality measurement, risk adjustment, clinical analytics, population health, care management, utilization management, and provider performance.
Demonstrated understanding of Medicare, Medicaid, Marketplace, Dual, and Commercial healthcare populations and their associated analytics requirements.
Proven ability to lead enterprise-scale analytics and reporting strategies and translate data into meaningful business outcomes.
Strong understanding of data governance, analytics architecture, business intelligence, and modern data platforms.
Experience working with senior executives and cross-functional stakeholders to influence strategy and drive organizational change.
Strong analytical, financial, strategic-thinking, and problem-solving capabilities.
Excellent communication and presentation skills, with the ability to explain complex technical and analytical concepts to both technical and non-technical audiences.
Demonstrated leadership skills, including the ability to attract, develop, motivate, and retain high-performing analytics professionals.
Ability to operate effectively in a complex, fast-paced, highly regulated healthcare environment while balancing strategic priorities with execution.
Benefits:
Annual salary range: $161,914.25–$315,732.79, with actual compensation varying based on factors such as geographic location, experience, education, and skill level.
Full-time employment with an executive-level opportunity to shape enterprise data and analytics strategy.
Competitive compensation and benefits package designed to support professional and personal well-being.
Opportunities to lead transformative initiatives spanning clinical informatics, quality, risk adjustment, AI/ML, and enterprise analytics .
Opportunity to build and develop high-performing teams and influence analytics capabilities at an enterprise level.
Exposure to strategic initiatives across Medicare, Medicaid, Marketplace, Dual, and Commercial populations.
Collaborative environment with close partnership across technology, data, clinical, and business leadership functions.
Equal opportunity workplace committed to an inclusive and respectful professional environment.
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