Data Analyst – Clinical

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Clinical Data Analyst will serve as the strategic analytics partner to our UM (Utilization Management) and MRA (Medical Records Audit) operations. You will design, develop, and deliver data solutions in support of driving productivity, surfacing ROI opportunities, supporting optimization efforts, and maintain Audit readiness. Working in close collaboration with Clinical leadership, UM, and Process Improvement teams, the Analyst will translate operational objectives into technical requirements, conduct ad hoc analyses for audit and regulatory reporting, and present actionable insights to leadership.

The analyst will need to be comfortable working between strategic planning and providing agile operational support. This role demands a blend of technical skills (SQL, BI Tooling, Python), strong subject matter expertise with familiarity in a Healthcare setting, and excellent communication skills to drive decisions to be rooted in data and solutions are sustainable.

Job Duties/Responsibilities:

• Develop and maintain interactive dashboards and scorecards that track key performance indicators along with other metrics in support of strategic initiatives
• Collect, clean, and integrate various datasets to ensure reliable analytics foundations
• Analyze UM data, including IP and prior authorizations outcomes, to measure performance against ROI commitments and identify cost-saving opportunities
• Collaborate with UM and MRA leaders to define KPIs and translate ROI objectives into actionable analytic deliverables
• Build monitoring frameworks for various clinical workflows to quantify process improvement scopes and prioritize initiatives, including data quality issues
• Conduct ad hoc analyses and variance reporting to support audit preparation, ensuring readiness for internal and external reviews
• Support MRA initiatives by analyzing medical record audit data to track denial rates, cost avoidance, and revenue recovery metrics
• Translate complex data into executive-level presentations, Data Story Telling
• Identify and lead automation opportunities within UM and MRA operations to enhance efficiency and reduce manual effort

Job Requirements:

Experience:

• Required:
  • Minimum 3 years of experience in data analysis or clinical analytics, including dashboard/report development and variance analysis
• Preferred:
  • 2+ years’ experience in Medicare Advantage Plans
  • 2+ years’ experience in a healthcare environment, preferably in Utilization Management

Education:

• Required: High School Diploma or GED.  Bachelor's degree or four years’ additional experience in lieu of education.
• Preferred: Degree in Health Informatics, Data Science, Business Analytics or related quantitative field

Specialized Skills:

Required:

• Proficiency in SQL
• Ability to develop Analysis with BI Tools (Power BI, Tableau)
• Working knowledge of Python or other languages for data manipulation
• Proficiency in Microsoft Products (Excel, PowerPoint, etc…)
• Ability to communicate positively, professionally and effectively with others
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors
• Ability to prioritize multiple tasks; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate solution
• Time management skills and ability to work in a fast-paced environment
• Ability to tell the story through data

Preferred: Certifications related to Data Analysis / Data Engineering

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus

Pay Range: $77,905.00 - $116,858.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.