Job Description
The Lead Analytics Consultant, Utilization Management will be responsible for conducting and/or coordinating all data, reporting and analytic functions for all activities within the UM team. In this role he/she will partner with Informatics to manage UM reporting initiatives, including specialty UM trend monitoring and reporting. He/she will collaborate closely with other leaders on the UM team to assure timely, consistent and superior work products and to create a high-performance culture within the team. He/she will create and maintain strong working relationships with colleagues in MEU, Informatics, Utilization Management and the Medicaid Health Plans.

• Conduct data queries and analyses as requested for all programs and activities of the UM; display and explain the data in a manner that enhances team insights
• Maintain routine reporting of team specialty UM performance
• Support coding and editing activities with code level authorization, utilization and claims data; routinely track the utilization impact of prior authorization changes
• Monitor available clinical reports and dashboards for actionable segment trends
• Collaborate with MEU and Informatics as needed; share outcomes of analyses with other departments as appropriate
• Contribute actively to the creation of a high-performance team culture

Required Qualifications
-Ability to perform queries of claims and authorization databases required
-Advanced knowledge of analytic programming tools and methods (SAS, SQL, OLAP, PowerBI, etc.)
-Experience in working in data warehouse environment as well as the ability to work with large data sets from multiple data sources
-Strong reporting skills using Excel, Word, PowerPoint, PowerBI.
-Strong problem solving and critical thinking ability
-Strong communication and collaboration skills within and across teams
-Demonstrated extensive and diverse knowledge of health care data, metrics and standards
-5+ years of experience in Managed Care required; Medicaid experience preferred

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

• If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

• If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
• Knowledge of health plan operations, including claims payment, savings initiatives, utilization and financial reporting preferred
• Progressive leadership roles in medical management preferred
• Experience in clinical trend reporting and analysis preferred

Education
Education :
• Bachelors required
• Masters degree in Health Care Administration or related field preferred

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.