Director, Health Plan Informatics

Role Overview

• Owns the data and analytics infrastructure that powers financial and operational decision-making across a large, self-funded health plan serving tens of thousands of members
• Establishes the governance, platform, and capability of the Emory Health Plan.
• Works closely with clinical operations and pharmacy leadership.
• Owns responsibility for EHP's analytics platform and the data governance architecture that makes every KPI, dashboard, and financial scorecard trustworthy and auditable.
• Owns and governs all Arcadia dashboards across cost, quality, utilization, population risk, pharmacy, and financial performance domains, and serves as EHP's internal authority on the Arcadia platform.
• Manages the full Vista environment including Foundry backend, dataset management, provider and payer hierarchies, and access controls, and builds platform independence by developing internal capability to reduce reliance on external vendor execution.
• Defines KPI ownership across the organization, maintains a plain-language data dictionary, and establishes and monitors data quality controls through reconciliation of Arcadia figures against TPA, PBM, Stop Loss, and general ledger sources on a defined schedule.
• Designs, implements, and maintains data pipelines supporting finance, clinical, and operational reporting, owning the full chain from source system to executive dashboard, and builds and maintains executive-ready views across financial performance including MLR trending, high-cost claimant monitoring, budget vs. actual, OKR financial scorecards, benefits design tracking, and vendor ROI.
• Designs and maintains the data layer supporting SLA monitoring and performance guarantees for TPA and PBM vendors, covering turnaround time, financial accuracy, reject/rework rates, and call center metrics, and owns integration of non-Arcadia feeds, including SLA reports, rebate files, prior authorization data, and appeals/grievances, into the analytics environment.
• Evaluates and recommends complementary tools or infrastructure where Arcadia has gaps, including assessment of a Power BI layer as a supplemental reporting environment, and maintains a central KPI catalog with a formal change-control process so metric definitions do not fragment across teams.
• Serves as EHP's primary day-to-day contact for Guidehealth, managing build requests, issue resolution, training program execution, and contractual scope, and leads EHP's internal analytics training program, including Arcadia super-user certification and self-service reporting standards, with the goal of organizational independence from vendor dependency.
• Defines and recruits future junior analytics positions reporting to this role as the informatics function matures and documents all data sources, analytical methodologies, and platform configurations to support organizational continuity.
• Co-owns pharmacy data analytics with the Director of Clinical Analytics, owning pharmacy data infrastructure within Arcadia including drug classification, fill reporting, specialty vs. non-specialty dynamics, and pharmacy-related dashboard views.
• Ensures all actuarial models, including trend analyses, IBNR, and pricing scenarios, are supported by reliable, versioned data pipelines, and embeds data QA and reconciliation support for actuarial analyses as a standing responsibility so the actuarial function consumes governed data rather than maintaining shadow pipelines.
• Maintains explicit accountability for data access controls, minimum necessary standards, and PHI/PII handling across all analytics environments, and supports ERISA/CAA/Parity transparency requirements with accurate, auditable data extracts.
• Performs related responsibilities as required.

Requirements

• Bachelor's degree in health informatics, information systems, data science, healthcare administration, or related field required
• Master's degree or advanced certification in health informatics or analytics preferred
• 7+ years of progressive experience in health plan or managed care analytics, with significant depth in health plan data environments including claims, eligibility, quality measures, and total cost of care
• Demonstrated experience leading or supervising staff or vendor relationships, with the ability to develop team members and create a clear path for advancement
• Proficiency with at least one major health plan or enterprise clinical analytics platform (Epic, Arcadia, Health Catalyst, Lightbeam, or equivalent) required
• Experience in a health plan or managed care data environment required; Arcadia experience preferred
• Strong data visualization skills and experience managing an external analytics vendor relationship, including setting build priorities, writing requirements, and QAing deliverables against hard deadlines
• Deep technical knowledge of health plan data environments including claims, eligibility, attribution, quality measures, utilization, and pharmacy data (Medispan or equivalent)
• Experience with analytics platform governance including KPI architecture, dashboard design, data pipeline management, access controls, and data quality controls.
• Breadth across care settings in hospital, physician group, and health plan with an understanding of how data flows from clinical delivery into a health plan analytical environment.

Benefits

• Health and safety information not applicable