Senior Informaticist

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The Senior Informaticist serves as a strategic analytics partner supporting Humana Clinical Pharmacy Review (HCPR) and the pharmacy Prior Authorization (PA) process. You will work with business leaders, clinical and operational partners, and analytics teams to translate complex business and operational challenges into analytical questions, investigate the drivers of performance, and develop meaningful recommendations.

The Senior Informaticist will use governed data and modern analytical tools to evaluate Prior Authorization activity and operational performance, identify trends and opportunities, investigate potential drivers of outcomes, and help business partners understand not only what is occurring, but why it is occurring and what actions may improve results.

Your success requires a combination of healthcare and pharmacy knowledge, analytical curiosity, and business partnership. You are comfortable working with Prior Authorization, pharmacy claims, membership, clinical, operational, and other healthcare data while operating within a regulated environment.

The Senior Informaticist serves as a strategic problem solver supporting Humana Clinical Pharmacy Review and pharmacy Prior Authorization operations. You will partner across business, clinical, operations, technology, and analytics teams to address complex and often ambiguous challenges affecting PA processes, operational performance, regulatory reporting, and outcomes.

You will identify opportunities, framing problems, evaluating data and potential solutions, and developing recommendations that help HCPR leaders make informed decisions. Success requires the ability to create clarity in complex situations, understand the operational processes behind the data, and develop practical solutions when perfect information is not available.

Important responsibilities include:

• Lead complex analytical programs supporting HCPR and pharmacy Prior Authorization, with accountability from problem identification through recommendation, implementation, and measurement of results.
• Translate complex or ambiguous PA, clinical, operational, and business questions into structured analytical approaches and applicable recommendations.
• Analyze Prior Authorization activity and operational performance to identify trends, potential drivers, process gaps, and opportunities for improvement.
• Combine information across multiple data sources and operational processes to develop a complete view of performance and identify causes.
• Partner with HCPR leadership and teams to support regulatory and compliance reporting requirements and evolving pharmacy needs.
• Develop analytical frameworks, reporting solutions, and decision-support tools that improve transparency and promote informed decision-making.
• Communicate complex findings, assumptions, risks, and recommendations to all audiences, including senior leadership.
• Take ownership of analytical projects, independently determining appropriate approaches, partner engagement, analytical requirements, and deliverables.
• Identify opportunities to improve PA reporting, operational processes, data quality, and analytical capabilities while challenging assumptions and driving sustainable solutions.
• Support modernization of HCPR analytics through tools and platforms such as Databricks and Power BI, while maintaining appropriate data governance and reporting standards.

We are looking for someone with exceptional critical thinking, intellectual curiosity, and the ability to connect data, Prior Authorization processes, regulatory requirements, and partner needs to practical solutions. You should be comfortable working in an environment where priorities can change quickly, the underlying business problem may not initially be fully defined, and analytical findings need to be translated into meaningful action.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree and 5+ years of experience solving complex business problems through analytics, healthcare operations, informatics, strategy, consulting, engineering, or related disciplines.
• Strong analytical and critical-thinking skills with the ability to define problems, establish analytical approaches, and develop solutions when an established process may not exist.
• Experience translating business and operational goals into measurable analytical approaches and outcomes.
• Experience summarizing information across diverse data sources and identifying trends, relationships, and potential causes.
• Strong communication and stakeholder-management skills, including the ability to communicate complex analytical findings to all audiences.
• Demonstrated ability to use data and analytical reasoning to influence action rather than simply producing analyses or reports.
• Experience working with healthcare, pharmacy, Medicare, Medicaid, CMS, claims, Prior Authorization, or population health data.
• Experience with analytical technologies such as SQL, Databricks, Power BI, Python, Tableau, or similar tools.
• Manage complex analytical efforts involving multiple business and technical partners.
• Experience working within regulated environments where data accuracy, governance, compliance, and reporting integrity are critical.

Preferred Qualifications

• Experience with pharmacy Prior Authorization or utilization management processes.
• Experience supporting Medicare or Medicaid pharmacy operations and regulatory reporting.
• Knowledge of pharmacy claims, clinical review, coverage determination, or related pharmacy operational processes.
• Experience developing enterprise reporting solutions using Databricks and Power BI.
• Advanced degree in a quantitative, analytical, healthcare, business, or technical field.
• Experience in informatics, healthcare analytics, process improvement, consulting, strategy, or operations research.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay 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.$97,900 - $133,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 11-13-2026

About 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.