Data Science & AI Manager - NLP/Risk Adjustment Must Have

Job Summary:

The Data Science and AI Manager is responsible for the development and application of cutting-edge advanced analytics solutions using traditional ML algorithms and emerging Artificial Intelligence (AI) technologies such as Natural Language Processing (NLP) and Generative AI solutions to enhance healthcare operations, patient care, and overall health plan performance and efficiency. This position requires a highly skilled AI expert capable of leading and delivering complex data science projects independently while mentoring and guiding a team of data scientist.

Essential Functions:

• Stay updated on the latest trends in NLP, Generative AI, and healthcare informatics, integrating these advancements into the team’s projects to drive continuous innovation
• Utilize NLP algorithms and other deep learning techniques to process and analyze unstructured healthcare data, such as clinical notes, patient feedback, and medical literature, to extract meaningful insights
• Lead a team specializing in NLP and predictive analytics, ensuring the successful delivery of projects that align with organizational goals
• Work closely with interdisciplinary teams across IT, risk adjustment, program integrity, HEDIS, healthcare operations, finance, and clinical departments to identify and capitalize on opportunities for data-driven innovative solutions using cutting-edge emerging technologies
• Develop and implement predictive models, algorithms, and statistical techniques to extract insights from large and complex healthcare datasets
• Utilize machine learning algorithms to identify patterns, trends, and opportunities for improving operational efficiency, cost containment, and patient care
• Conduct rigorous data analysis, including data cleansing, feature engineering, and exploratory data analysis, to derive meaningful insights and actionable recommendations
• Collaborate with stakeholders to define key performance indicators (KPIs), develop metrics, and create dashboards and reports that effectively communicate insights and support decision-making
• Provide strategic guidance and recommendations to senior leadership based on data analysis and predictive modeling results
• Ensure compliance with data privacy and security regulations and maintain the highest standards of data integrity
• Lead cross-functional projects as a hands-on leader, with occasional light project management across teams to deliver results
• Lead by example – motivating, mentoring, and collaborating with teammates to further the department’s objectives
• Represent the department in project meetings and other meetings that require subject matter knowledge and input
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree in Data Science, Mathematics, Statistics, Engineering, Computer Science, other related field, or equivalent years of relevant work experience is required
• Master’s degree or PhD is preferred
• Minimum of eight (8) years of experience in predictive analytics, data science, or a related field, preferably within the healthcare industry or managed care organizations required
• Minimum of five (5) years of experience in the healthcare industry required
• Minimum of one (1) year of experience with cloud services (such as Azure, AWS or GCP) and modern data stack (such as Databricks or Snowflakes) is required
• Minimum of one (1) years of experience in development and deployment of an NLP and Generative AI solution in the healthcare industry is required
• Project management experience preferred

Competencies, Knowledge and Skills:

• Strong expertise in statistical modeling, machine learning techniques, and predictive analytics tools such as Python, or R
• Expert in data manipulation, data visualization, and SQL for data extraction and analysis
• Expert in MS office (Excel, PowerPoint, Word, Access)
• Ability to perform advanced statistical analysis and modeling such as liner and non-liner regression, sampling, and Markov chains
• Expertise in emerging technologies and tools such as large language models, natural language understanding, sentiment analysis, named entity recognition, topic modeling, and text classification
• Expertise in Optical Character Recognition (OCR) technologies, including data extraction from scanned documents, forms, and invoices, and proficiency in OCR tools and libraries
• Experience with web app and API development and deployment in production environment
• Detailed knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM data, and demographic and population data
• Knowledge of healthcare operations, payer and provider models, and industry trends
• Proficient in feature engineering techniques and exploratory data analysis
• Knowledge of optimization techniques and artificial intelligence methods
• Excellent analytical, problem-solving, and critical-thinking skills, with the ability to translate complex data into actionable insights
• Strong project management skills, with the ability to lead and prioritize multiple projects simultaneously in a fast-paced environment
• Excellent written and verbal communication and presentation skills, with the ability to convey technical concepts to non-technical stakeholders
• Leadership qualities, including the ability to mentor and develop a team, foster collaboration, and drive results
• Comfortable reading academic research papers and applying them in the models

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.