About the company
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Operating Effectiveness Senior Analyst - EviCore based in the United States.
This role connects clinical operations, business processes, technology, and decision-support systems to improve how complex healthcare programs operate at scale. You'll design and optimize clinical and operational workflows, business rules, algorithms, and automated decision-support solutions.
Responsibilities
- Design, develop, maintain, and optimize clinical decision-support pathways, business rules, algorithms, and automated workflows
- Translate clinical guidelines, business requirements, regulatory standards, and client needs into system logic, workflow configurations, pathways, and decision-support solutions
- Partner with Clinical, Operations, Product, Technology, Data, and Business teams to identify opportunities for automation, AI integration, workflow simplification, and improved operational effectiveness
- Apply data analysis, critical thinking, and root cause analysis to resolve operational challenges
- Develop scalable solutions that enhance clinical decision-making, automated rationale generation, letter production, utilization management operations, and overall user experience
- Conduct functional, regression, and quality assurance testing
- Monitor system performance, operational metrics, and user feedback
- Create and maintain process documentation, standard operating procedures, workflow diagrams, training materials, and governance controls
- Support new program implementations, enhancements, and enterprise initiatives
- Ensure solutions align with applicable regulatory, accreditation, compliance, privacy, and quality standards, including HIPAA, NCQA, and URAC requirements
- Use reporting, analytics, and emerging AI technologies to generate insights
Requirements
- Bachelor's degree in Science, Healthcare Administration, Computer Science, Data Analytics, Mathematics, Information Systems, or a related field, or equivalent professional experience
- Experience in healthcare operations, utilization management, clinical decision support, product operations, process improvement, or business systems analysis
- Strong analytical and problem-solving abilities, with excellent communication and stakeholder management skills
- Demonstrated ability to translate business requirements into workflows, decision logic, pathways, algorithms, or system configurations
- Familiarity with workflow design tools, business rules engines, Visio, SharePoint, Tableau, SQL, Databricks, or comparable analytics and process automation technologies is preferred
- Experience supporting AI-enabled solutions, automation initiatives, intelligent workflow platforms, or decision-support technologies is preferred
- Ability to balance hands-on operational execution with strategic thinking, innovation, and continuous improvement
- For remote work, a cable broadband or fiber optic internet connection with minimum speeds of 10 Mbps download and 5 Mbps upload is required
Conditions
- Annual salary of $63,400–$105,600 USD, depending on relevant factors including experience and geographic location
- Eligibility to participate in an annual bonus plan
- Medical, vision, and dental benefits starting on day one
- Well-being and behavioral health programs
- 401(k) plan
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays and leaves of absence
- Remote work environment