Clinical Utilization

Valora Medical Group is a high-performing, risk-based primary care provider group focused on delivering exceptional patient outcomes while managing healthcare resources efficiently. We are seeking a data-driven leader to join our team and help optimize the way our clinics utilize specialists, diagnostics, pharmacy resources, and other medical services.

At Valora, we believe exceptional care begins with exceptional people, and we're proud to support a culture of collaboration, innovation, accountability, and integrity.

Job Summary:

The Manager, Clinical Utilization & Performance Analytics will monitor, analyze, and improve utilization patterns across our network to ensure care aligns with evidence-based standards and value-based performance goals. This role focuses on referral management, diagnostic utilization, medical services monitoring, and pharmacy optimization.

The ideal candidate brings with them 5+ years of healthcare data analytics, quality improvement, and utilization review experience within managed care.

This position provides a high level of support to executive leadership, clinical and performance operations, and management.

Essential Duties and Responsibilities:

• Develop and maintain policies for specialist and diagnostic referrals that ensure appropriateness, timeliness, and alignment with best practices.
• Monitor provider referral patterns, identifying trends, outliers, and opportunities to improve in-network utilization.
• Track and analyze utilization of inpatient, outpatient, ER, urgent care, and other medical services to reduce avoidable use.
• Monitor prescribing patterns for high-cost and specialty drugs; identify opportunities for generic substitution and improved adherence.
• Conduct in-depth claims and EMR data analysis to identify cost drivers and opportunities for performance improvement.
• Create dashboards and reports to share actionable insights with providers and leadership.
• Partner with medical directors and quality teams to design and implement utilization improvement initiatives.
• Educate providers on utilization trends, benchmarks, and evidence-based care guidelines.
• Perform other duties as assigned to meet business and departmental needs.

Qualifications/Education:

• Bachelor's degree in Nursing, Health Administration, or related healthcare field required; Master's Degree is preferred
• Clinical background (RN, PharmD, NP, PA) preferred but not required with strong analytics experience.
• 5+ years of experience in healthcare analytics, quality improvement, or utilization review within a provider group, ACO, or risk-based care environment.
• Proven experience in referral and diagnostic utilization analysis.Highly proficient with database analysis and design
• Proficiency in data analytics tools (Excel, SQL, or similar)
• 5+ years' experience with data visualization tools such as Tableau or Power BI
• Proficient in compiling and reporting on managed care data, including visualization that tells a story
• Experience of clinical data management experience, preferably using the eClinicalWorks (eCW) EMR system
• Strong communication skills, both verbal and written, and ability to influence provider practice patterns through data and collaboration.
• Ability to make decisions in a timely fashion that are sound, accurate, and supported by the reasoning and inclusion of the appropriate people
• Must be able to prioritize and accomplish objectives at an acceptable level
• Ability to establish working relationships, resolve interpersonal conflicts, and apply basic staff etiquette in dealing with others
• Ability to handle confidential information with discretion
• Exceptional analytical skills with attention to detail
• Ability to learn new procedures and quickly adapt to change
• Innovative, motivated, organized, and team player
• Follow through with commitments
• Ability to work independently and in a fast-paced environment
• Proactive and self-starter

Why Join Us?

• Competitive salary + performance bonus
• Comprehensive health, dental, and vision insurance
• Competitive 401(k) with employer match
• Paid time off and professional development opportunities
• Mission-driven organization with a culture of innovation and teamwork

EEO Statement: Valora Medical Group, LLC is an equal opportunity employer and does not discriminate on the basis of race, color, religion, creed, sex, national origin, age, disability, pregnancy status, sexual orientation, gender identity, veteran status, marital status, genetic information, citizenship status, or other status protected by law. In compliance with the Immigration Reform and Control Act of 1986, we will hire only U.S. citizens and aliens lawfully authorized to work in the United States.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Application Question(s):

• Will you now, or in the future, require sponsorship for employment visa status (e.g. H-1b Visa status)?
• What is your desired salary?
• Please list all EMR systems you have experience using:
• On a scale of 1 to 5, how would you rate your proficiency in Microsoft Excel? (1 - Little experience, 5 = Expert-level proficiency)
• On a scale of 1 to 5, how would you rate your proficiency in data visualization tools? (1 - Little experience, 5 = Expert-level proficiency)
• Do you have experience as an RN, PharmD, Nurse Practitioner, or Physician Assistant?

Education:

• Bachelor's (Required)

Experience:

• Healthcare Utilization Management: 5 years (Preferred)
• Managed care: 5 years (Preferred)
• Healthcare Data Analytics: 5 years (Preferred)

Ability to Commute:

• Orlando, FL Required)

Work Location: In person