Medical Informatics Analyst, Consultant- Utilization Management

Your Role The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Medical Informatics, Consultant will report to the Manager of HQA Analytics. In this role you will be supporting Utilization Management Operations, with a strong emphasis on post-service analysis to assess cost of healthcare outcomes, identify opportunities for improvement, and inform decision‑making. You will also lead the transformation of complex post service data into structured, high‑quality datasets and actionable intelligence, enabling effective operational oversight and continuous performance optimization. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high‑performing teams, getting results the right way, and fostering continuous learning. Your Knowledge and Experience Requires a college degree or equivalent experience Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent Requires at least 7 years of prior relevant experience Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer) Requires at least 2 years in one or more dashboard/BI tools, such as Power BI or Tableau. Strong understanding of data modeling concepts, and experience with SQL for data extraction, transformation, and validation. Familiarity with data transformation tools such as DBT and Power Query. Experience with Utilization Management, Financial, and/or Claims data, with knowledge in prior authorization, retrospective authorization, and/or post-service review strongly preferred. Hybrid This role requires employees to be in‑office based on our hybrid workplace model, balancing purposeful in‑person collaboration with flexibility. For most teams, this means coming into office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in‑office time based on business need. #J-18808-Ljbffr Blue Shield of CA