Principal Clinical Informatics Analyst (Full Time, Remote, North Carolina Based)

The Principal Clinical Informatics Analyst supports the organization’s clinical and operational goals by collecting, analyzing, and interpreting healthcare data. This role develops dashboards, reports, and data visualizations that inform decision-making across departments. The Principal Clinical Informatics Analyst collaborates across departments to ensure data accuracy, optimize reporting tools, and enhance the usability of clinical platforms. The Principal Clinical Informatics Analyst work directly supports strategic initiatives and improves the efficiency and effectiveness of front-line staff. In addition, the Principal Clinical Informatics Analyst leads complex analytical initiatives, translates business requirements into scalable reporting solutions, and drives the adoption of clinical technologies and informatics tools that enhance workflow efficiency and frontline staff effectiveness.

This position will allow the successful candidate to work a schedule that will be primarily remote. While there is no expectation of being in the office routinely, they will be required to come into the Alliance Office for business and team meetings as needed.

Responsibilities & Duties

Data & Workflow Analysis

• Analyze existing clinical workflows to identify areas for improvement and optimization by collaborating with departmental leadership and clinical trainers
• Lead the Development and maintenance of process documentation to support front line staff
• Ensures system configuration accurately reflects workflows in collaboration with IT, compliance and Quality NCQA leadership
• Ensure workflows remain compliant with state regulatory and NCQA requirements in collaboration with compliance and Quality NCQA leadership
• Analyze large volumes of patient and health data to identify trends and opportunities for improvement in patient outcomes and operational efficiency

HEDIS Lifecycle Support & Analytics

• Subject matter expert (SME) for the National Committee for Quality Assurance (NCQA) HEDIS Measures. (Hybrid, Administrative and ECDS)
• Review the quality of HEDIS internal processes/plans for alignment with procedures and/or best practices for supporting the HEDIS Team.
• Responsible for participating in the development, research, and implementation of HEDIS improvement activities
• Interpret qualitative and quantitative information and appropriately document/share findings
• Makes recommendations for improvement related to HEDIS Measures, Process and report findings
• Identify system and/or operational issues hindering the attainment of quality performance standards as defined by NCQA, applicable state and Federal laws and regulations
• Motivate, influence, and provide direction to staff assigned to the Hybrid and NCQA projects to ensure successful completion of project goals, deliverables, and timelines
• Analyze and interpret technical specifications, business requirements, and regulatory guidance to support accurate implementation of HEDIS measures and project activities
• Serve as a subject matter expert on NCQA and HEDIS resources, providing guidance, training, and consultation to project teams
• Identify and escalate situations which may pose quality, compliance, and/or safety risks that may adversely affect the HEDIS Hybrid Audit, HEDIS Prospective Audit or SDVA Audit

System Implementation and Integration

• Support Clinical Informatics Function, releases and enhancements by assisting in business requirement development in collaboration with IT and Clinical Trainer
• Serve as a liaison between clinical staff and the IT department, bridging the gap between technical solutions and clinical workflows to drive data-driven improvements
• Collaborates with IT system configuration teams to improve system functionality

Data Management

• Review, analyze, and report on data from internal users across clinical operations and delegates to ensure accuracy and operational excellence. Information is submitted on schedule as required to Leadership as frequent as daily, monthly and/or quarterly
• Ensure data management practices align with healthcare standards, focusing on accuracy, patient safety, and regulatory compliance
• Identify and mitigate risks associated with the use of clinical informatics systems, including (but not limited to) interoperability of systems and system downtime
• Collect, analyze and interpret healthcare data to support decision-making processes to ensure quality performance and improve patient outcomes

Develop Reports and Data Visualization Solutions

• Perform data acquisition, analysis, evaluation, and analytics via advanced SQL queries and stored procedures, MicroStrategy, and other data management tools
• Design solutions using BI concepts including dynamic and parameter driven reporting, dashboards, data visualization, and alerts
• Lead the design and development of products that merge data from various sources including EDI files, HIE, State data, transactional system, and data warehouse
• Provide support, as required, to ensure the accuracy of developed reports and metrics for both external and internal users
• Ensure that reporting activities are conducted in ways that correspond with externally mandated specifications
• Provide consultative and analytical support to leadership, communicating the outcomes of analyses to guide decision-making and solve business problems
• Perform geocoding activities through GIS software to analyze spatial statistics

Regulatory Compliance and Audit Readiness

• Ensure the accuracy and integrity of the clinical data systems, while adhering to regulatory requirements (NCQA, EQRO, etc.)
• Facilitate appropriate CM, UM, QM and PHM readiness team for regulatory bodies above in preparation for internal/external record audits and site audits
• Own the documentation of compliance (bookmarking) with standards
• Oversight of Monthly State and NCQA Reporting prior to delivering to compliance and/or quality NCQA team

Minimum Requirements

Education & Experience

Required:

Bachelor's degree in Computer Science, Engineering, Healthcare Informatics, or a related field from an accredited college/university and seven (7) years of experience in healthcare field operating informatics in supporting analytic functions within Health Insurance Industry.

Or

Master’s degree in Computer Science, Engineering, Healthcare Informatics, or a related field from an accredited college/university and five (5) years of experience in healthcare field operating informatics and analytics functions within Health Insurance Industry.

Additional requirements:

• Experience with the NCQA Technical Specifications and Value Set Directory.
• Understanding of the operational requirements for data collection in support of HEDIS or similar Quality programs.
• Experience with the Medicaid population related to HEDIS Measures.
• Experience with Medical Record Abstraction/Quality Analysis and oversight of HEDIS related duties for HEDIS to include the supplemental data audit, Prospective audit and Hybrid audit.

Preferred:

• A Master's degree in Healthcare Informatics is preferred.
• Certification in Health Informatics (e.g., Certified Health Informatics Systems Professional - CHISP) is preferred.

Knowledge, Skills, & Abilities

• Clinical experience in a healthcare setting.
• Strong presentation, collaboration, and communication skills.
• Strong attention to detail, critical thinking, and problem-solving capabilities.
• Demonstrated skills in computer software, spreadsheets, databases and modeling programs.
• Experience collecting user requirements, translating to system feature enhancements.
• Knowledge of State and NCQA regulatory requirements.
• Ability to work independently and in a team setting
• Ability to manage multiple priorities, and assess and adjust quickly to changing priorities
• Knowledge of data analysis on databases/data sets
• Excellent written communication skills, including technical writing and document design principles
• Advanced experience with SQL

Salary Range

$91,192 - $116,270/ Annual

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity

An excellent fringe benefit package accompanies the salary, which includes:

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility

Employment for this position is contingent upon a satisfactory background check and credit check, which will be performed after acceptance of an offer of employment and prior to the employee's start date.