Director Data Operations

JOB SUMMARY

A critical focus of this role is driving the organization's healthcare interoperability strategy by championing seamless, bidirectional clinical and administrative data exchange between Highmark and its provider network. This flow of data is essential to optimizing core health plan operations, including case management, utilization management, risk programs, government quality programs, and claims processing.

This job ensures the availability, performance and stability of processes that create, store and deliver data for internal and external stakeholders.  To achieve this, the incumbent will lead teams that monitor, maintain and support an efficient and reliable production environment for all of Highmark Health’s analytic and operational data platforms.  This includes reactive and proactive support for data engineering patterns that ingest, transform, and curate data; processes that create enriched datasets for use by data consumers; automation of key data product processes (e.g., ACGs, HEDIS); and access to and/or exchange of data through APIs and interoperable feeds.   The incumbent will also manage effective and efficient quality control processes to ensure data are trustworthy and robust change control processes that balances our need to be nimble with the requirement of high quality and accuracy.  

ESSENTIAL RESPONSIBILITIES

• Lead the strategic roadmap and execution for healthcare data exchange, leveraging deep expertise in both payer and provider technology ecosystems (e.g., EHR/EMR platforms like Epic and Oracle) to bridge technical and operational gaps.
• Ensure robust data integration utilizing modern healthcare standards (e.g., HL7 V2, FHIR) to directly support and improve clinical workflows, population health initiatives, and payer-provider alignment.
• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Monitor, maintain, and support the operational and analytic data platforms and technology, working closely with IT partners to ensure the group is leveraging the latest tools and technology.  Oversee an efficient and effective quality control process that tests and reviews all code and processes to ensure accuracy.   Create an overall production and continuous improvement discipline that not only delivers on quality, but continuously lowers our cost to deliver.
• Support data and analytic end-users and stakeholder needs for appropriate data access, awareness, understanding, and troubleshooting to ensure successful information delivery.
• Reliably deliver all assets that exist within the production environment (e.g., data sources, curated datasets, APIs, data feeds, analytic & business intelligence tools) on a timely and accurate basis such that end-users can be more efficient and effective in their job.
• Act as the liaison to the Organization's broader data governance processes, data engineering teams, and other key information technology partners. Act as a critical link to IT and our external plan partners who are leveraging our analytical tools.
• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Information Technology, Computer and Information Science, Computer Engineering, Health Informatics or related field

Substitutions

• 6 years of relevant work experience in lieu of a bachelor’s degree
   

Preferred

• Master's Degree in Information Technology, Computer and Information Science, Computer Engineering or related field

EXPERIENCE

Required

• 7 years in Data Analytics

Preferred

• 10+ years of dedicated experience in healthcare interoperability and clinical data exchange
• 15+ years in Healthcare IT delivery, requiring significant foundational experience on the provider side combined with strategic experience on the payer side
• 5+ years shaping and executing healthcare technology strategy

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Healthcare Interoperability (HL7, FHIR, APIs)
• Clinical Data Exchange & Integration Engines
• Healthcare IT Strategy & Delivery
• Payer & Provider Ecosystem Alignment
• Health Plan Operations (Utilization Management, Risk, Claims)
• EHR/EMR Platform Integration
• Healthcare Information Systems
• Health Information Management
• Talent Management
• IT Operations

Language (Other than English)

None 

Travel Required

0%  - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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