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Humana Lead clinical informaticist in Boston, Massachusetts

Description

Come join the Digital Health & Analytics (DH&A) team within Humana to build a world class Data Science and Insights enterprise capability leveraging digital-first platforms, analytics, and agile development methodologies.

An opportunity to join the Digital Health & Analytics (DH&A) team within Humana to build a world-class analytics platform. Through the strategic interpretation of data, we provide our consumers-physicians, patients, and other members of the care team with meaningful insights about the choices they make and help them lead their best lives. We are passionate about combining and analyzing diverse types of data to extract new, actionable discoveries about our members and their health-related behaviors. We are looking for driven, innovative people who are interested in using their clinical and analytical skills to help our consumers achieve lifelong well-being and help Humana make lasting, positive changes in the healthcare industry. As a clinical informaticist at Humana you will contribute to meaningful projects, interact with other team members, be exposed to DH&A's business operations and work cross functionally with other departments.

Responsibilities

  • Apply understanding of clinical and financial metrics to various data sets to help in the creation and implementation of clinical solutions based on advanced analytics

  • Partner with analytics leaders and peers to understand business problems, elicit requirements, develop analysis and reporting specification, and deliver results according to project plan

  • Apply knowledge in clinical terminology to map and group clinical codes to support various analytics projects

  • Provide clinical governance and validation on analytics solutions

  • Develop requirements and technical specifications for clinical rules and predictive models

  • Implement clinical rules with in-house developed rule language

  • Develop and review test cases for different analytics solutions

  • As SME in clinical informatics, coordinate with product management, IT and other business areas across the organization to support product development and adoption

  • Apply knowledge of clinical analytics processes to drive clinical efficiencies and effectiveness

  • Use informatics science to design or implement health information technology applications to enhance care management efficiency

  • Identify, collect, record or analyze data that are relevant to the optimal clinical care of patients

  • Design, develop, select, test, implement, and evaluate new or modified clinical informatics solutions

  • Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

  • Provide training to junior team members on clinical terminology management

Required Qualifications

  • MD or DO

  • Expert in clinical terminology management with extensive experience and knowledge in LOINC, ICD 9/10, CPT, HCPCS , SNOMED CT, etc.

  • Strong knowledge of managed care data reporting and analysis such as HEDIS, quality of care studies, benchmarking, predictive modeling and risk stratification, etc.

  • In depth knowledge and experience with FDB, Medi-Span or other drug databases

  • Ability to translate data into meaningful information in report or presentation formats.

  • 3-5 years of experience in mapping and grouping clinical codes to clinical concepts at different granularity levels, data analysis experience using EMR or claims data

  • 2 or more years of data analytics experience using medical and pharmacy claims data

  • Good knowledge and experience in health data exchange standard including FHIR, HL7, CCDA

  • Proficiency in using data analytics technologies such as SQL, python, Power BI

  • Strategic thinking and planning capabilities

  • Organized and detail-oriented

  • Excellent verbal and written communication

  • Ability to teach others who are not expert in your clinical discipline

  • Experience creating a wide variety of documentation, paperwork, communications in an effort to advance a project or process

Preferred Qualifications

  • Advanced Degree in clinical informatics

  • Expertise in data mining and/or predictive modeling

Additional Information

Scheduled Weekly Hours

40

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