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Senior Director, Clinical Data Governance and Integration

Role overview

Qualifications

  • Bachelor's degree in Health Informatics, Public Health, Data Science, Healthcare Administration, or related field required
  • Seven (7) years of progressive experience in healthcare analytics, clinical data integration, interoperability, or managed care operations required
  • Five (5) years of leadership experience in a managed care or healthcare organization required
  • Advanced understanding of healthcare data architecture, including clinical, claims, enrollment, provider, and supplemental data domains.

Responsibilities

  • Leads the execution of enterprise clinical data governance and integration strategies.
  • Establish and maintain a comprehensive clinical data inventory inclusive of data sources, attributes, ingestion pathways, ownership, downstream use cases, and refresh cadence.
  • Develop and maintain standardized business requirement templates for clinical data acquisition.
  • Drive clinical data use cases from concept through implementation.

About the company

CareSource logo

CareSource

Insurance

Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for nearly 30 years and we will continue to be a transformative force in the industry by placing people over profits. CareSource is and will always be members first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to nearly 2 million members through plan offerings including Marketplace, Medicare Advantage and Medicaid. With our team of 4,000 employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve. CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law. If you’d like more information about your EEO rights as an applicant under the law, please click here: https://www.eeoc.gov/employers/upload/poster_screen_reader_optimized.pdf and here: https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf Si usted o alguien a quien ayuda tienen preguntas sobre CareSource, tiene derecho a recibir esta información y ayuda en su propio idioma sin costo. Para hablar con un intérprete, Por favor, llame al número de Servicios para Afiliados que figura en su tarjeta de identificación. 如果您或者您在帮助的人对 CareSource 存有疑问,您有权 免费获得以您的语言提供的帮助和信息。 如果您需要与一 位翻译交谈,请拨打您的会员 ID 卡上的会员服务电话号码。

Company details

Company typeLarge
IndustryInsurance
Company size1001 - 5000

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Job description

Job Summary:

The Senior Director, Clinical Data Governance & Integration is responsible for developing, executing and coordinating enterprise clinical data governance and integration activities. This role ensures standardized business requirements, oversees governance cadence, and drives cross-functional alignment across clinical data users to support enterprise growth objectives.

Essential Functions:
  • Leads the execution of enterprise clinical data governance and integration strategies.
  • Establish and maintain a comprehensive clinical data inventory inclusive of data sources, attributes, ingestion pathways, ownership, downstream use cases, and refresh cadence.
  • Develop and maintain standardized business requirement templates for clinical data acquisition.
  • Oversee governance activities related to acquisition opportunities and data quality performance, ensuring effective documentation, risk escalation, and decision-making.
  • Identifies and recommends clinical data acquisition opportunities by reviewing emerging trends, regulatory changes, and competitive intelligence.
  • Drive clinical data use cases from concept through implementation — including business case development, requirements definition, technical coordination, testing, deployment, value tracking, and post-implementation optimization.
  • Partner with Enterprise IT and Data Engineering to prioritize ingestion pipelines and interoperability enhancements (e.g., HL7/FHIR).
  • Oversees performance monitoring related to clinical data vendors.
  • Ensure governance guardrails are maintained to prevent fragmented, duplicative, or misaligned clinical data acquisition efforts across business units.
  • Serve as liaison between business domains and enterprise governance forums to ensure alignment with broader enterprise data strategy.
  • Lead and develop a team of analysts responsible for data profiling, reconciliation, acquisition evaluation, quality monitoring, and roadmap support.
  • Perform any other job related duties as requested.

Education and Experience:
  • Bachelor's degree in Health Informatics, Public Health, Data Science, Healthcare Administration, or related field required
  • Master's degree in related field preferred
  • Equivalent years of relevant work experience may be accepted in lieu of required education
  • Seven (7) years of progressive experience in healthcare analytics, clinical data integration, interoperability, or managed care operations required
  • Five (5) years of leadership experience in a managed care or healthcare organization required
  • Experience working cross-functionally with IT, Quality, Risk Adjustment, Care Management, and Finance stakeholders required
Competencies, Knowledge and Skills:
  • Advanced understanding of healthcare data architecture, including clinical, claims, enrollment, provider, and supplemental data domains.
  • Strong understanding of enterprise data platforms (e.g., data warehouses, cloud data lakes such as Snowflake, Azure, AWS, GCP).
  • Working knowledge of SQL (ability to review queries, validate outputs, and challenge analytic logic; hands-on querying experience preferred).
  • Knowledge of Clinical Quality entities and national interoperability frameworks, including TEFCA, QHIN participation models, HIE partnerships, and CMS-aligned data exchange initiatives.
  • Familiarity with healthcare interoperability standards including FHIR, HL7, CCD/CCDA, and API-based data exchange models.
  • Skilled in overseeing ingestion, normalization, and governance of clinical data sources (HIEs, lab feeds, EMR extracts, vendor files).
  • Strong understanding of data quality frameworks (completeness, timeliness, conformance, integrity, duplication management).
  • Skilled in implementing enterprise data governance models (data ownership, stewardship, lineage, metadata management).
  • Ability to evaluate vendor technical capabilities and negotiate data delivery standards, file layouts, SLAs, and quality thresholds.
  • Understanding of CMS Stars, HEDIS, CAHPS, Risk Adjustment, and regulatory reporting data requirements.
  • Familiarity with modern BI and analytics tools (Power BI, Tableau, Python/R environments) sufficient to guide strategy and challenge outputs.
  • Skilled in reducing manual data workflows through automation and system integration.
  • Ability to lead and influence in a highly matrixed environment.
  • Ability to translate technical data strategies into executive-ready business narratives.
Licensure and Certification:
  • Certifications such as CHDA, PMP, Lean Six Sigma, or advanced analytics credentials preferred
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • Ability to travel as required by the needs of the department.

Compensation Range:

$135,600.00 - $237,400.00

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. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

  • Fostering a Collaborative Workplace Culture

  • 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 environment of belonging that welcomes and supports individuals of all backgrounds.

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