Data Analyst Utilization and Care Management

Job SummaryThe Data Analyst will support Utilization Management (UM) and Care Management (CM) programs by analyzing healthcare data, identifying trends, and delivering actionable insights that improve member outcomes, operational efficiency, and cost management. This role requires experience working with health plan data such as claims, authorizations, care management activities, and quality measures. The analyst will collaborate with clinical, operational, and leadership teams to develop dashboards, reports, and analyses that support strategic decision-making. Essential Functions/Key Responsibilities: Analyze Utilization Management (UM) and Care Management (CM) data including authorizations, inpatient and outpatient utilization, case management activity, and member outcomes. Develop and maintain dashboards and reports tracking key performance indicators such as: Admission rates Readmissions Length of stay Authorization turnaround times Care management engagement Cost and utilization trends Perform claims, eligibility, provider, and authorization data analysis to identify utilization patterns, high-cost drivers, and opportunities for intervention. Support population health and risk stratification efforts by analyzing member cohorts and identifying high-risk populations. Partner with clinical leadership, UM nurses, and CM teams to translate data insights into operational improvements. Design and automate recurring reports for UM/CM leadership and health plan executives. Perform ad-hoc analysis to support regulatory reporting, quality initiatives, and program evaluations. Ensure data accuracy by validating datasets and collaborating with data engineering or IT teams. Monitor program performance and measure the impact of UM and CM interventions on cost, utilization, and quality metrics. Present findings and recommendations to clinical and operational stakeholders. Required education and experience: Bachelor’s degree in Data Analytics, Health Informatics, Statistics, or a related field 3–5+ years of data analytics experience in a health plan, payer, or managed care organization Experience analyzing Utilization Management (UM) and/or Care Management (CM) data Strong proficiency with Python or SQL for querying healthcare datasets Experience creating and working with data visualization tools (Tableau, Power BI, or similar) Understanding of healthcare claims, authorizations, and eligibility data Strong analytical, problem-solving, and communication skills Preferred education, certifications and/or experience: Experience with population health analytics Knowledge of HEDIS, CMS quality metrics, or value-based care programs Experience working with large healthcare datasets Familiarity with risk adjustment models (HCC, RAF, CDPS, CRG, ACG) Advanced experience with Python, SQL, R, or advanced statistical analysis Master’s degree in Health Informatics, Data Science, or related field Physical Requirements/Work environment: Remote role with occasional travel (Less than 5%) Must have a home office, mobile phone, computer with security requirements met. Prolonged periods of sitting at a desk and working on a computer. Ability to speak, hear, and comprehend both written and verbal communications. Other duties: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without advanced notice. Pay: $64,803.69 - $78,043.15 per year Education: Bachelor's (Required) Experience: data analytic health plan: 3 years (Required) UM or CM data analysis: 1 year (Required) Python or SQL: 2 years (Required) Work Location: Remote