[Hiring] Senior Informaticist @Humana

Role Description

The Senior Informaticist serves as a strategic analytics partner supporting Humana Clinical Pharmacy Review (HCPR) and the pharmacy Prior Authorization (PA) process. You will work with business leaders, clinical and operational partners, and analytics teams to translate complex business and operational challenges into analytical questions, investigate the drivers of performance, and develop meaningful recommendations.

The Senior Informaticist will use governed data and modern analytical tools to evaluate Prior Authorization activity and operational performance, identify trends and opportunities, investigate potential drivers of outcomes, and help business partners understand not only what is occurring, but why it is occurring and what actions may improve results.

Your success requires a combination of healthcare and pharmacy knowledge, analytical curiosity, and business partnership. You are comfortable working with Prior Authorization, pharmacy claims, membership, clinical, operational, and other healthcare data while operating within a regulated environment.

Important responsibilities include:

• Lead complex analytical programs supporting HCPR and pharmacy Prior Authorization, with accountability from problem identification through recommendation, implementation, and measurement of results.
• Translate complex or ambiguous PA, clinical, operational, and business questions into structured analytical approaches and applicable recommendations.
• Analyze Prior Authorization activity and operational performance to identify trends, potential drivers, process gaps, and opportunities for improvement.
• Combine information across multiple data sources and operational processes to develop a complete view of performance and identify causes.
• Partner with HCPR leadership and teams to support regulatory and compliance reporting requirements and evolving pharmacy needs.
• Develop analytical frameworks, reporting solutions, and decision-support tools that improve transparency and promote informed decision-making.
• Communicate complex findings, assumptions, risks, and recommendations to all audiences, including senior leadership.
• Take ownership of analytical projects, independently determining appropriate approaches, partner engagement, analytical requirements, and deliverables.
• Identify opportunities to improve PA reporting, operational processes, data quality, and analytical capabilities while challenging assumptions and driving sustainable solutions.
• Support modernization of HCPR analytics through tools and platforms such as Databricks and Power BI, while maintaining appropriate data governance and reporting standards.

Qualifications

• Bachelor's degree and 5+ years of experience solving complex business problems through analytics, healthcare operations, informatics, strategy, consulting, engineering, or related disciplines.
• Strong analytical and critical-thinking skills with the ability to define problems, establish analytical approaches, and develop solutions when an established process may not exist.
• Experience translating business and operational goals into measurable analytical approaches and outcomes.
• Experience summarizing information across diverse data sources and identifying trends, relationships, and potential causes.
• Strong communication and stakeholder-management skills, including the ability to communicate complex analytical findings to all audiences.
• Demonstrated ability to use data and analytical reasoning to influence action rather than simply producing analyses or reports.
• Experience working with healthcare, pharmacy, Medicare, Medicaid, CMS, claims, Prior Authorization, or population health data.
• Experience with analytical technologies such as SQL, Databricks, Power BI, Python, Tableau, or similar tools.
• Manage complex analytical efforts involving multiple business and technical partners.
• Experience working within regulated environments where data accuracy, governance, compliance, and reporting integrity are critical.

Requirements

• Experience with pharmacy Prior Authorization or utilization management processes.
• Experience supporting Medicare or Medicaid pharmacy operations and regulatory reporting.
• Knowledge of pharmacy claims, clinical review, coverage determination, or related pharmacy operational processes.
• Experience developing enterprise reporting solutions using Databricks and Power BI.
• Advanced degree in a quantitative, analytical, healthcare, business, or technical field.
• Experience in informatics, healthcare analytics, process improvement, consulting, strategy, or operations research.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.
• Many other opportunities.

Company Description

CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment, and more. Our unique care model focuses on personalized experiences, taking time to listen, learn, and address the factors that impact patient well-being.

CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive, and, most of all, personalized.