Health Plan Clinical Analyst and Data Scientist

Position Summary Health Plan Clinical Analyst and Data Scientist drives enterprise clinical performance strategy by overseeing analytics, regulatory reporting frameworks, and operational intelligence that support clinical, care and utilization management, and quality initiatives. This role translates complex healthcare data into executive-level insights, leads cross-functional analytics efforts, and ensures alignment between clinical operations, compliance priorities, and organizational strategy.

Serving as an analytics partner to clinical leadership, this role provides subject-matter expertise in utilization trends, clinical performance, and quality measurement while advancing scalable reporting infrastructure that improves outcomes and regulatory readiness. Key

Responsibilities - Clinical Analytics Leadership Lead the design, development, and optimization of enterprise clinical performance dashboards (e.g., utilization, care management effectiveness, access metrics, and quality performance). Development of recurring and adhoc analytics using SQL, Excel, and Power BI. Translate complex clinical datasets into strategic recommendations for executive leadership, operational teams, and quality stakeholders.

Establish data validation standards and ensure accuracy, completeness, and integrity across reporting environments. Serve as a senior subject-matter expert for clinical analytics methodologies, performance measurement, and reporting best practices. - Stakeholder Partnership & Strategic Influence Partner with clinical and operational leadership to define KPIs aligned with enterprise performance goals.

Lead cross-functional collaboration with IT, data engineering, operations, and quality teams to improve data architecture and reporting accessibility. Present insights and narratives to senior stakeholders in clear, decision-ready formats. Guide prioritization of analytics initiatives supporting organizational strategy and regulatory requirements.

Mentor junior analysts and strengthen analytics capabilities across teams. - Regulatory, Accreditation & Quality Analytics Partner with Compliance and clinical stakeholders to support state, federal and health plan reporting requirements, including NCQA, CMS, JOC. Development of performance metrics used in audits, accreditation readiness, and compliance monitoring.

Support enterprise readiness for regulatory reviews through proactive analytics monitoring and documentation. - Continuous Improvement & Analytics Governance Drive automation of manual reporting workflows and implementation of scalable reporting solutions. Establish documentation standards, reporting governance processes, and analytics best practices.

Lead initiatives to modernize clinical reporting infrastructure and improve enterprise data usability. Identify opportunities to leverage analytics for performance optimization and cost-of-care improvement. Education & Experience Bachelor's degree (or equivalent experience) in public health, data analytics, health informatics, business, or a related field.

5+ years of experience with advanced proficiency in SQL, Excel, and Power BI 3+ years of experience working with healthcare plan datasets, including claims, utilization management/prior authorization, care management, and quality measures. Strong understanding of clinical workflows, utilization and network management analytics, and healthcare economics.

Demonstrated ability to translate complex analytics into executive-level insights and operational recommendations. Excellent stakeholder engagement, communication, and strategic problem-solving skills. Self-starter with the ability to manage multiple priorities independently.

Preferred Qualifications Experience mentoring analysts and leading analytics workstreams or initiatives. Experience with data science tools and programming languages such as Python or R