Consulting Practice Leader – Healthcare Provider Data SME

• Job Title – Consulting Practice Leader – Healthcare Provider Data SME
• Job Location – Remote-NJ/NY/PA, Boston, Philadelphia, or SF Bay Area preferred
• Job Type: Full-Time
• We are hiring a senior leader to own and scale that Commercial business.
• The Consulting Practice Leader serves as the primary Subject Matter Expert (SME) and strategic advisor on healthcare provider data for a enterprise-level hospital system client. In this ongoing role, you will bridge the gap between technical data engineering teams, clinical informatics, enterprise analytics, and executive business partners. You will design, govern, and optimize healthcare provider data assets—ensuring data products, reference data models, and Subject Area Data Models align with clinical operations, credentialing, revenue cycle, and digital health initiatives.

• Key Responsibilities
• 1. Enterprise Data Product & Domain Strategy
• Lead the definition, development, and governance of core Provider Data Products (e.g., Provider 360, Master Provider Index/EMPI, Practitioner Directory, Provider Network & Alignment, Provider Roster Management).
• Define domain-specific data architectures and data lifecycle strategies across clinical, administrative, credentialing, and billing domains.
• Establish data product ownership models, domain definitions, and lifecycle management frameworks for provider-centric data assets.

• 2. Subject Area & Industry Data Modeling
• Architect and refine Provider Subject Area Data Models across key domains: Provider Master Data, Credentialing & Privileging, Network/Payer Contracts, Scheduling/Availability, Provider Attribution, and Clinical Performance.
• Guide the adoption and customization of standard industry data models and frameworks (e.g., HL7 FHIR Practitioner/PractitionerRole resources, OMOP CDM, CAQH standards, and vendor enterprise models such as Epic Clarity/Caboodle provider schemas or Cerner CCL).
• Standardize reference data, taxonomy mappings, and code sets across the health system (e.g., NPI, NUCC Provider Taxonomy, State License IDs, CAQH, Provider Specialty Groups).

• 3. Client Advisory & Cross-Functional Alignment
• Serve as the trusted advisor to hospital system executives (CDO, CIO, Chief Medical Officer, VP of Revenue Cycle) on provider data strategy and data quality initiatives.
• Drive cross-departmental alignment between Provider Enrollment, Medical Staff Services, Clinical Operations, IT/Data Engineering, and Managed Care Contracting.
• Establish and facilitate data governance bodies specific to Provider Data Quality, Stewardship, and Integration.

• 4. Data Governance, Quality & Stewardship
• Implement data quality frameworks, stewardship workflows, and automated validation pipelines tailored to complex provider entities (individual vs. organizational providers, affiliations, locations, and panel capacities).
• Establish MDM (Master Data Management) and Identity Resolution protocols to solve multi-source provider duplicate, merge, and alignment issues across disparate systems.

• Required Skills & Expertise
• Healthcare Provider Data Knowledge
• Provider Data Sub-Domains: Deep expertise in Provider Master Data (MDM), Practitioner vs. Organizational Provider distinction, Medical Staff Credentialing/Privileging, Provider Attribution, Panel Management, and Provider-Location-Specialty relationships.
• Standard Industry Models & Protocols: In-depth knowledge of HL7 FHIR (Practitioner, Practitioner Role, Healthcare Service, Location resources), CAQH, NUCC Taxonomy, and relational/analytical dimensional modeling for healthcare.
• Health System Source Systems: Hands-on familiarity with EHR data models (Epic Clarity/Caboodle, Cerner), Credentialing systems (e.g., Echo, Cactus, Symplr), and Provider Directory / MDM solutions (e.g., Informatica, Reltio, IBM MDM).
• Reference Data & Identifiers: Master-level understanding of NPI (NPPES), DEA, State Licensing, Medicare/Medicaid Enrollment (PECOS), taxonomy codes, and taxonomy crosswalks.

• Consulting & Leadership Skills
• Advisory Leadership: Proven experience leading long-term data transformation engagements within large integrated delivery networks (IDNs) or academic medical centers.
• Data Product Management: Ability to manage data assets as products—defining roadmap, user stories, schema specifications, and business value metrics.
• Stakeholder Facilitation: Strong track record of aligning technical teams (ETL, Data Warehousing, Cloud Data Engineers) with business/clinical stakeholders.

Qualifications

• Experience: 8+ years in healthcare data domain consulting or enterprise health system informatics, with a focus on provider data architecture, data governance, and data warehousing.
• Education: Bachelor’s or master’s degree in health informatics, Computer Science, Information Systems, or a related quantitative field.
• Certifications (Preferred): FHIR Certification, Certified Health Data Analyst (CHDA), or Enterprise Data Governance certifications (e.g., CDMP).

• Education
• Bachelors or Master’s degree in Computer Science, Information Technology or relevant field