Informatics Lead

Humana

2d • Remote

About The Position

The Informatics Lead is responsible for providing advanced analytical support and oversight for Medicaid Prior Authorization (PA) reporting. This role will drive informatics initiatives that directly support HCPR Risk Management, Medicaid Customer Success, and Medicaid Pharmacy Directors, enabling data-driven decision-making across these domains. The Informatics Lead will collaborate with cross-functional teams to maintain a thorough knowledge of PA processes and the state-specific reporting requirements necessary to ensure regulatory compliance and promote operational excellence. This position requires strong technical expertise, leadership abilities, and a commitment to upholding Humana’s data governance standards.

Requirements

• Bachelor’s or Master’s degree in Informatics, Computer Science, Data Science, Health Information Management, or a related field.
• Minimum of 5 years’ experience in data analytics, with demonstrated expertise in SQL coding and querying large-scale tables (1 billion+ rows).
• Proficient in Power BI, including Paginated Reporting and writing DAX queries.
• Strong understanding of data governance, privacy, and regulatory compliance, particularly within healthcare or Medicaid environments.
• Excellent communication, organizational, and technical documentation skills.

Nice To Haves

• Medicaid reporting experience, specifically in utilization management or prior authorization processes.
• Experience working with Databricks for data processing and analytics.
• Experience translating state-specific reporting requirements into actionable data solutions.
• Familiarity with cloud-based data platforms and advanced analytics methodologies.
• Professional certification in informatics, data analytics, or related disciplines.

Responsibilities

• Provide advanced analytical support for Medicaid Prior Authorization (PA) reporting, ensuring alignment with regulatory requirements and organizational goals.
• Collaborate with cross-functional teams, including HCPR Risk Management, Medicaid Customer Success, and Medicaid Pharmacy Directors, to maintain comprehensive knowledge of PA processes and state-specific reporting requirements.
• Develop, refine, and oversee the implementation of data solutions that support Medicaid PA initiatives and operational excellence.
• Ensure the integrity, accuracy, and security of Medicaid PA data in compliance with organizational and state regulations.
• Monitor and interpret state-specific Medicaid reporting guidelines, adapting informatics workflows as needed to ensure ongoing compliance.
• Communicate complex data findings and insights effectively to stakeholders with varying levels of technical expertise.
• Mentor and support junior informatics staff, fostering a collaborative and high-performance team environment.
• Oversee documentation, standard operating procedures, and knowledge management related to Medicaid PA analytics.
• Participate in enterprise data governance activities and promote best practices in data management across the organization.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

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