Lead Director, Operational Analytics

Role Overview

• Lead the operational reporting efforts on the Healthcare Affordability team
• Work with the clinical strategists to identify performance metrics of each of their workgroups, identify opportunities and assist in developing performance metrics to gauge the success of their workgroup
• Produce executive-level summaries of overall performance and opportunities of the HcA team
• Integrate with the broader Healthcare Affordability team to ensure consistent tracking and reporting of work
• Support the story-telling and opportunities available for all the Total Cost of Care programs being managed by the HcA team
• Prepare summary metrics for reporting to senior leaders the opportunities and risks in meeting year-end goals
• Support ideation for long-term cost of care strategies and analytic needs
• Comfortable working with Medical and Clinical staff within Aetna CM/UM, Medical Policy, and Clinical Informatics
• Works with MEU and other enterprise analytic teams to identify new data, metrics or views needed to support affordability, quality and outcomes improvement initiatives
• Partner with clinical and medical directors to identify, assess and prioritize potential scorable action items
• Work across the Aetna business to identify sources of healthcare cost and trend data currently available in all lines of business: Commercial, Medicare and Medicaid
• Analyzes data, healthcare trends and provides suggested actions from data
• Work closely with Medical Economics Unit (MEU), Analytical & Behavior Change (A&BC), and other areas that have currently available analytic tools to identify sources of healthcare cost and utilization trend and SAI performance data
• Develop internal tools, using Power BI, ThoughtSpot or similar solution to bring in high level data points from disparate data sets across Aetna to be used in understanding cost trends and drivers in support of Hotspot and POD ideation teams
• Work with leaders across business units to identify data sources and solutions available to support total cost of care initiatives
• Works with finance, data engineering and IT to bring solutions and ideation to completion
• Supports business unit’s ideation and business case strategy with analytic thought leadership, modeling and suggestions

Requirements

• A minimum of 10 years of direct healthcare experience within a large payer organization, with a focus on healthcare analytics, program evaluation, or outcomes measurement
• Proven track record of developing analytic solutions and operating effectively within a cross-functional, matrixed environment
• Demonstrated ability to adapt and perform in a dynamic, evolving business landscape
• Ability to identify performance gaps and translate business needs into actionable analytic solutions
• Experience in clinical and provider-based analytics, including forecasting, trend analysis, and projections
• Experience working with claims data, including detailed line-item analysis and payment operations
• Familiarity with CM (Care Management), UM (Utilization Management), and other clinical operations and provider datasets
• Solid understanding of clinical workflows, chronic disease management, care management programs, and value-based care (VBC) concepts
• Excellent written and verbal communication skills, with the ability to translate complex technical findings into clear insights for non-technical stakeholders
• Prior people management experience, including coaching, development, and training of team members, is preferred
• Experience with data visualization and analytics tools such as Tableau, ThoughtSpot, or Quickbase is a plus

Tech Stack

• Tableau

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs