Medical Informatics Manager

Your Role

The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Sr. Manager, Medical Informatics - Utilization Management (UM) Analytics will report to the Director of HQA Analytics and lead a team responsible for Prior Authorization, Concurrent Review, and broader UM analytics. This leader will translate clinical and operational priorities into actionable analytical strategies, strengthen organizational understanding of utilization and authorization performance, develop team capabilities, and deliver insights that inform operational improvement, executive decision-making, affordability, quality, and member outcomes across lines of business.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

Your Work 
In this role, you will:

• Lead, develop, and mentor a team of analysts supporting Prior Authorization, Concurrent Review, and broader UM analytics
• Define and execute the UM analytics strategy and roadmap in alignment with organizational, clinical, regulatory, and affordability priorities
• Serve as the primary analytics partner to Prior Authorization, Concurrent Review, and Medical Management leadership, translating business needs into actionable analytical strategies
• Oversee analytics related to authorization volume, approval and denial rates, decision timeliness, inpatient utilization, length of stay, avoidable days, readmissions, and other key UM performance indicators
• Evaluate the impact of UM programs, clinical policies, prior authorization requirements, and operational interventions on utilization, cost, quality, and member and provider experience
• Direct complex analyses integrating authorization, clinical, membership, provider, claims, and financial data to identify performance gaps, emerging risks, and improvement opportunities
• Partner with Medical Management, Network Management, Claims, Pharmacy, Appeals and Grievances, Compliance, Finance, Product, Technology, and data teams to deliver comprehensive insights and recommendations
• Oversee the development of dashboards, recurring reporting, self-service tools, and executive performance summaries using Tableau, Power BI, and other analytical platforms