Operating Effectiveness Senior Analyst - EviCore - Remote

The Operating Effectiveness Senior Analyst serves as a critical link between clinical operations, business processes, technology, and decision support systems. This role designs, implements, and optimizes clinical and operational workflows, business rules, algorithms, and automated decision-support solutions that enable scalable, efficient, and compliant utilization management programs. The analyst translates complex business and clinical requirements into system logic, pathways, and AI-enabled workflows that improve decision quality, operational efficiency, user experience, and organizational scalability.

Responsibilities include pathway development, algorithm configuration, process improvement, quality assurance, root cause analysis, workflow optimization, and collaboration with clinical, operational, product, and technology teams.
** Key Responsibilities
*** Design, develop, maintain, and optimize clinical decision-support pathways, business rules, algorithms, and automated workflows that enable consistent, accurate, and scalable operational outcomes.
* Translate clinical guidelines, business requirements, regulatory standards, and client needs into system logic, workflow configurations, and decision-support solutions.
* Partner with Clinical, Operations, Product, Technology, Data, and Business stakeholders to identify opportunities for automation, AI integration, workflow simplification, and operational effectiveness improvements.
* Leverage data analysis, critical thinking, and root cause methodologies to resolve operational issues, improve outcomes, and drive continuous process improvement initiatives
* Develop scalable solutions that enhance clinical decision-making, automated rationale generation, letter production, utilization management operations, and user experiences
* Conduct functional, regression, and quality assurance testing to ensure accuracy, compliance, performance, and reliability of implemented solutions.
* Monitor system performance, user feedback, and operational metrics 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 implementation of new programs, enhancements, and enterprise initiatives through testing, training, deployment, and change management activities.
* Ensure solutions align with regulatory, accreditation, compliance, privacy, and quality standards including HIPAA, NCQA, and URAC requirements.
* Utilize reporting, analytics, and emerging AI technologies to identify insights, improve decision accuracy, reduce manual effort, and increase operational scalability.
** Qualifications
* ** Bachelor's degree in Science, Healthcare Administration, Computer Science, Data Analytics, Mathematics, Information Systems, or a related field, or equivalent experience.
* Experience in healthcare operations, utilization management, clinical decision support, product operations, process improvement, or business systems analysis.
* Strong analytical, problem-solving, communication, and stakeholder management skills.
* Experience translating business requirements into workflows, decision logic, pathways, algorithms, or system configurations.
* Knowledge of workflow design tools, business rules engines, Visio, SharePoint, Tableau, SQL, Databricks, or similar analytics and process automation technologies preferred
* Experience supporting AI-enabled solutions, automation initiatives, intelligent workflow platforms, or decision-support technologies preferred.
* Ability to balance operational execution with strategic thinking, innovation, and continuous improvement.  If you will be working at home occasionally or…