The Informatics Lead is responsible for providing advanced analytical support and oversight for Medicaid Prior Authorization (PA) reporting. This role will drive informatics initiatives that directly support HCPR Risk Management, Medicaid Customer Success, and Medicaid Pharmacy Directors, enabling data-driven decision-making across these domains. The Informatics Lead will collaborate with cross-functional teams to maintain a thorough knowledge of PA processes and the state-specific reporting requirements necessary to ensure regulatory compliance and promote operational excellence. This position requires strong technical expertise, leadership abilities, and a commitment to upholding Humana’s data governance standards.
- Provide advanced analytical support for Medicaid Prior Authorization (PA) reporting, ensuring alignment with regulatory requirements and organizational goals.
- Collaborate with cross-functional teams, including HCPR Risk Management, Medicaid Customer Success, and Medicaid Pharmacy Directors, to maintain comprehensive knowledge of PA processes and state-specific reporting requirements.
- Develop, refine, and oversee the implementation of data solutions that support Medicaid PA initiatives and operational excellence.
- Ensure the integrity, accuracy, and security of Medicaid PA data in compliance with organizational and state regulations.
- Monitor and interpret state-specific Medicaid reporting guidelines, adapting informatics workflows as needed to ensure ongoing compliance.
- Communicate complex data findings and insights effectively to stakeholders with varying levels of technical expertise.
- Mentor and support junior informatics staff, fostering a collaborative and high-performance team environment.
- Oversee documentation, standard operating procedures, and knowledge management related to Medicaid PA analytics.
- Participate in enterprise data governance activities and promote best practices in data management across the organization.
Use your skills to make an impact
Required Qualifications:
- Bachelor’s or Master’s degree in Informatics, Computer Science, Data Science, Health Information Management, or a related field.
- Minimum of 5 years’ experience in data analytics, with demonstrated expertise in SQL coding and querying large-scale tables (1 billion+ rows).
- Proficient in Power BI, including Paginated Reporting and writing DAX queries.
- Strong understanding of data governance, privacy, and regulatory compliance, particularly within healthcare or Medicaid environments.
- Excellent communication, organizational, and technical documentation skills.
Preferred Qualifications:
- Medicaid reporting experience, specifically in utilization management or prior authorization processes.
- Experience working with Databricks for data processing and analytics.
- Experience translating state-specific reporting requirements into actionable data solutions.
- Familiarity with cloud-based data platforms and advanced analytics methodologies.
- Professional certification in informatics, data analytics, or related disciplines.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 04-21-2026About us
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Top Skills
What We Do
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
