Director, Clinical Analytics - Emory Health Plan

Emory • Atlanta, GA

2d • Hybrid

About The Position

Emory Health Plan (EHP) serves as the analytical bridge between clinical performance and financial outcomes for a large, self-funded health plan serving tens of thousands of members. This role owns EHP's population health analytics function, leads clinical quality performance measurement, drives vendor ROI assessment, and supports the financial case for care management and benefits design investments. The Director presents data that informs how EHP bends medical and pharmaceutical trends and how leadership makes the highest-stakes financial decisions the plan faces. This includes owning member population cost stratification, emerging high-cost member identification, and longitudinal cost trajectory analysis. The role maps high-cost populations to diagnosis, care setting, and care management gaps, and identifies highest-yield opportunities to bend medical trend through care management gaps, avoidable utilization, site-of-care substitution, and specialty drug management. The Director produces prioritized opportunity matrices with estimated savings ranges and implementation complexity for executive decision-making. Additionally, the role owns quality measure analytics for EHP, including measure calculation, compliance reporting, gap analysis, and performance trends across relevant quality domains. Quality performance is translated into financial terms, quantifying the implications of quality gaps and improvements under value-based arrangements. The Director applies external benchmarking methodology to identify where EHP's clinical performance and cost differ from peers, tracks quality gate performance and utilization benchmarks under all value-based arrangements, and owns the clinical outcomes assessment layer of all vendor ROI scorecards. The role co-owns the clinical outcomes and utilization components of all vendor ROI scorecards and value-based arrangements, including quality gates, utilization benchmarks, and savings calculations. The Director partners with Finance and Actuarial to reconcile clinical performance against contractual guarantees and shared savings. The role assesses wellness platform and point solution vendors (including Maven, Hinge, and Flyte) with the same evidence standards applied to provider quality performance, supports value-based contract performance monitoring, and delivers ROI analysis on care management programs with measurable, Arcadia-grounded outcomes. In partnership with the AVP Finance EHP, the Director provides clinical and utilization analytics inputs to benefits design financial modeling, supports MLR decomposition and trend attribution by cohort, condition, site of care, and benefit design, and provides IBNR and reserve analyses with clinical and utilization context. The role supports stop-loss strategy by characterizing high-cost claimants and catastrophic cost patterns by diagnosis, care setting, and persistence. The Director serves as the finance function's analytical partner to clinical operations, pharmacy, and care management leadership. The role co-owns pharmacy analytics with the Director of Health Plan Informatics, including class of trade, specialty and biosimilar management, formulary and tiering performance, adherence analytics, and point solution impact. The role embeds PBM SLA and guarantee analytics and rebate/utilization reconciliation as standing responsibilities. The Director defines and maintains clinical analytics methodologies, including risk stratification logic, member attribution, and avoidable utilization definitions, in formal collaboration with the Director of Health Plan Informatics to prevent dueling definitions across teams. The role owns documentation of all clinical logic embedded in dashboards and reports to support auditability and organizational continuity. The Director leads and supervises analytical staff, providing mentoring in the areas of clinical analytics, quality measurement, population health, and crafting a financial story for leadership. The role provides training and guidance to direct reports and ensures that their skills are developed to add value to the team and create a clear path for advancement and success within the organization. Performs related responsibilities as required.

Requirements

• Bachelor's degree in clinical informatics, public health, health administration, statistics, economics, or a quantitative or life sciences discipline required.
• 7+ years of progressive experience in clinical analytics, quality measurement, or population health analytics in a complex healthcare organization.
• Demonstrated experience leading or supervising analytical staff, with the ability to develop team members and create a clear path for advancement.
• Proficiency with clinical or enterprise analytics platforms (Epic, Arcadia, or equivalent) required.
• Familiarity with quality measure frameworks including HEDIS or STARS; direct experience preferred, with demonstrated ability to ramp quickly.
• Experience with external benchmarking methodologies (Vizient or equivalent) and demonstrated ability to translate complex analytical findings into actionable recommendations for clinical, operational, and finance leadership.
• Deep knowledge of clinical data including EHR-sourced documentation, diagnosis and procedure coding, quality measure source data, and population analytics including cost stratification, risk segmentation, and avoidable utilization identification.
• Working knowledge of provider billing data and pharmacy analytics including drug classification, formulary performance, and adherence analysis.

Nice To Haves

• Master's degree in public health, health informatics, or healthcare administration preferred.

Responsibilities

• Owns EHP's population health analytics function, leads clinical quality performance measurement, drives vendor ROI assessment, and supports the financial case for care management and benefits design investments.
• Presents data that informs how EHP bends medical and pharmaceutical trends and how leadership makes the highest-stakes financial decisions the plan faces.
• Owns member population cost stratification, emerging high-cost member identification, and longitudinal cost trajectory analysis.
• Maps high-cost populations to diagnosis, care setting, and care management gaps.
• Identifies highest-yield opportunities to bend medical trend through care management gaps, avoidable utilization, site-of-care substitution, and specialty drug management, and produces prioritized opportunity matrices with estimated savings ranges and implementation complexity for executive decision-making.
• Owns quality measure analytics for EHP, including measure calculation, compliance reporting, gap analysis, and performance trend across relevant quality domains.
• Translates quality performance into financial terms, quantifying the implications of quality gaps and improvements under value-based arrangements.
• Applies external benchmarking methodology to identify where EHP's clinical performance and cost differ from peers, tracks quality gate performance and utilization benchmarks under all value-based arrangements and owns the clinical outcomes assessment layer of all vendor ROI scorecards.
• Co-owns the clinical outcomes and utilization components of all vendor ROI scorecards and value-based arrangements, including quality gates, utilization benchmarks, and savings calculations.
• Partners with Finance and Actuarial to reconcile clinical performance against contractual guarantees and shared savings.
• Assesses wellness platform and point solution vendors (including Maven, Hinge, and Flyte) with the same evidence standards applied to provider quality performance, supports value-based contract performance monitoring, and delivers ROI analysis on care management programs with measurable, Arcadia-grounded outcomes.
• Provides clinical and utilization analytics inputs to benefits design financial modeling, supports MLR decomposition and trend attribution by cohort, condition, site of care, and benefit design, and provides IBNR and reserve analyses with clinical and utilization context.
• Supports stop-loss strategy by characterizing high-cost claimants and catastrophic cost patterns by diagnosis, care setting, and persistence.
• Serves as the finance function's analytical partner to clinical operations, pharmacy, and care management leadership.
• Co-owns pharmacy analytics with the Director of Health Plan Informatics, including class of trade, specialty and biosimilar management, formulary and tiering performance, adherence analytics, and point solution impact.
• Embeds PBM SLA and guarantee analytics and rebate/utilization reconciliation as standing responsibilities.
• Defines and maintains clinical analytics methodologies, including risk stratification logic, member attribution, and avoidable utilization definitions, in formal collaboration with the Director of Health Plan Informatics to prevent dueling definitions across teams.
• Owns documentation of all clinical logic embedded in dashboards and reports to support auditability and organizational continuity.
• Leads and supervises analytical staff, providing mentoring in the areas of clinical analytics, quality measurement, population health, and crafting a financial story for leadership.
• Provides training and guidance to direct reports and ensures that their skills are developed to add value to the team and create a clear path for advancement and success within the organization.
• Performs related responsibilities as required.

Benefits

• Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
• Emory University does not discriminate in admissions, educational programs, or employment, including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training.
• Students, faculty, and staff are assured of participation in university programs and in the use of facilities without such discrimination.
• Emory University complies with Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veteran's Readjustment Assistance Act, and applicable executive orders, federal and state regulations regarding nondiscrimination, equal opportunity, and affirmative action (for protected veterans and individuals with disabilities).
• Inquiries regarding this policy should be directed to the Emory University Department of Equity and Civil Rights Compliance, 201 Dowman Drive, Administration Building, Atlanta, GA 30322.
• Telephone: [phone] (V) | 404-712-2049 (TDD).
• Emory University is committed to ensuring equal access and providing reasonable accommodations to qualified individuals with disabilities upon request.
• To request this document in an alternate format or to seek a reasonable accommodation, please contact the Department of Accessibility Services at [email protected] or call 404-727-9877 (Voice) | 404-712-2049 (TDD).
• We kindly ask that requests be made at least seven business days in advance to allow adequate time for coordination.

What This Job Offers

• Job Type: Full-time
• Career Level: Director