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.