Lead Clinical Data Integration & Interoperability

Pay Range:

$116,900.00 - $187,100.00

Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Why this job matters:

Responsible for leading end-to-end technical integration of BCBSRI’s core administrative systems, utilization management platforms, clinical data sources, enterprise data platforms, FHIR services, electronic health record systems, and external healthcare trading partners. Serves as the hands-on technical lead for interoperability and clinical data integration initiatives, ensuring the reliable, secure, and efficient exchange of clinical and administrative data across internal and external systems. Supports compliance with CMS interoperability requirements and the development of broader enterprise clinical data capabilities. Defines and guides integration approaches across APIs, FHIR services, data pipelines, middleware, messaging, batch interfaces, and event-driven solutions. Leads technical enablement of Patient Access, Provider Access, Provider Directory, Payer-to-Payer exchange, and electronic Prior Authorization capabilities, including CRD, DTR, and PAS workflows. Applies advanced healthcare integration expertise across core administration and utilization management systems, EHRs, HIEs, clinical data repositories, enterprise FHIR platforms, cloud data platforms, API gateways, and external health plan and vendor platforms.

What you will do:

• Lead the design and delivery of secure, scalable integrations across core administration, utilization management, clinical, enterprise data, FHIR, EHR, HIE, and external partner platforms.
• Define reusable integration patterns for APIs, batch processing, messaging, event-driven solutions, transformation, routing, orchestration, error handling, and reconciliation.
• Lead FHIR R4 solutions supporting Patient Access, Provider Access, Provider Directory, Payer-to-Payer exchange, and electronic Prior Authorization using applicable Da Vinci, US Core, CARIN, CDS Hooks, and SMART on FHIR standards.
• Direct the ingestion, transformation, mapping, validation, and reconciliation of clinical data from EHRs, HIEs, laboratories, providers, and vendors, ensuring data quality, provenance, and traceability.
• Design and optimize cloud-based APIs, integration services, and data pipelines across Azure, Snowflake, Apigee, and related technologies, including CI/CD and secure authentication and credential-management practices.
• Manage technical integrations with vendors and trading partners, including solution review, connectivity, onboarding, end-to-end testing, production readiness, and resolution of risks and dependencies.
• Establish testing, monitoring, logging, alerting, and incident-management standards; lead root-cause analysis and remediation of complex integration and data failures.
• Maintain technical documentation and provide technical direction to engineers, analysts, and vendor resources while coordinating decisions across Product, Engineering, Data, Architecture, Security, Infrastructure, and Operations.

• Perform other duties as assigned.

What you need to succeed:

• Seven or more years in systems integration, software engineering, data integration, or interoperability engineering, including three to five years focused on healthcare interoperability, clinical data exchange, or HL7/FHIR integration.
• Bachelor’s degree in Computer Science, Information Systems, Engineering, Health Informatics, or a related field, or an equivalent combination of education and related work experience.·
• Demonstrated experience implementing FHIR R4 APIs in a payer, provider, healthcare technology, or healthcare services environment, including hands-on integration with health plans, EHR vendors, HIEs, or UM vendors.
• Strong working knowledge of HL7 FHIR R4, HL7 Da Vinci guides (PDex, CRD, DTR, PAS, Plan-Net), US Core, CARIN Blue Button, CDS Hooks, and SMART on FHIR.
• Working knowledge of HL7 v2, C-CDA/CCD, REST APIs, JSON/XML, and healthcare messaging, plus integration patterns spanning batch, real-time, asynchronous, event-driven, and publish/subscribe.
• Strong understanding of payer data domains — member, coverage and eligibility, claims, encounters, provider, clinical, utilization management, and prior authorization — and familiarity with Facets or comparable core administration platforms.
• Hands-on experience with cloud integration and data technologies (Azure Data Factory, Azure Functions, Snowflake, Azure SQL, ADLS) and API gateway platforms (Apigee, MuleSoft, Azure API Management).
• Strong SQL skills for profiling, validation, mapping, reconciliation, and troubleshooting; working knowledge of OAuth 2.0, JWT/JWKS, mutual TLS, certificate management, and external API security.
• Experience with source control, CI/CD, automated deployment, and integration observability including logging, monitoring, alerting, and tracing.
• Excellent analytical, documentation, and communication skills, with the ability to translate business and regulatory requirements into technical integration designs and to explain complex concepts to business stakeholders.
• Demonstrated stakeholder and vendor management skills, comfort in Agile, Waterfall, and hybrid delivery models, and a strong ownership mindset for production reliability and data quality.

The extras:

• Experience with a health plan, provider organization, or healthcare interoperability technology company.
• Direct experience supporting CMS interoperability initiatives and implementing ePA workflows involving CRD, DTR, PAS, CDS Hooks, and UM platforms.
• Experience integrating with major EHR platforms (Epic, Oracle Health/Cerner, athenahealth, eClinicalWorks) and with HIEs, ADT feeds, laboratory feeds, C-CDA documents, and clinical APIs.
• Familiarity with X12 healthcare transactions such as 270/271 and 278.
• Relevant certifications such as HL7 FHIR, Azure Solutions Architect or Developer, AWS, MuleSoft, or Apigee.
• Experience with operational dashboards and monitoring (Grafana, Azure Monitor/Application Insights, Power BI) and incident management platforms such as ServiceNow

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visit  www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.

Why work here?

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visit  www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.