Operating Effectiveness Senior Analyst - EviCore

Accountabilities:

• • Design, develop, maintain, and optimize clinical decision-support pathways, business rules, algorithms, and automated workflows that deliver consistent, accurate, and scalable operational outcomes.
  • 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, improve outcomes, and support continuous process improvement initiatives.
  • 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 to verify the accuracy, compliance, performance, and reliability of implemented solutions.
  • Monitor system performance, operational metrics, and user feedback to identify enhancement opportunities and optimize decision-support workflows.
  • Create and maintain process documentation, standard operating procedures, workflow diagrams, training materials, and governance controls.
  • Support new program implementations, enhancements, and enterprise initiatives through testing, training, deployment, and change management activities.
  • 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, improve decision accuracy, reduce manual effort, and increase operational scalability.

  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.

  Benefits:

  • 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.