Principal Data Scientist - Clinical Operations

• Lead the design and development of advanced AI/ML solutions that transform clinical operations
• Drive innovation across care management, utilization review, and government programs
• Embed intelligent automation and predictive analytics into core workflows
• Build and maintain AI/ML models for disease progression forecasting, care management optimization, and clinical appeals triage
• Develop advanced question-answering pipelines to support evidence-based decision-making
• Implement multi-agent LLM workflows for clinical document interpretation, outreach strategy recommendations, and appeal resolution
• Customize LLMs to align with healthcare compliance (HIPAA, CMS), Aetna-specific terminology, and plan protocols
• Define KPIs and monitoring systems to ensure safety, fairness, and longevity of AI solutions
• Shape the AI roadmap for shared services such as appeals automation and digital care plans
• Develop and implement generative AI use cases through proof-of-concepts and internal training materials
• Partner with stakeholders in clinical operations, government programs, and innovation to co-design impactful AI solutions
• Promote responsible AI principles and empower clinical leaders to become AI change agents
• Collaborate with care advocates, medical directors, engineers, and product managers to integrate AI into platforms
• Resolve platform-level challenges in real-time eligibility checks, provider documentation review, and predictive triage
• Align AI designs with enterprise clinical strategy and IT architecture standards

• 10+ years of experience in applied machine learning, preferably in healthcare
• Proven track record of deploying AI/ML solutions in clinical or operational settings
• Expertise in LLMs, NLP, and multi-agent systems
• Strong understanding of healthcare data standards (Dx, Rx, CPT), compliance frameworks, and payer/provider workflows
• Excellent communication and stakeholder engagement skills
• Mastery of problem solving and decision-making skills
• Mastery of collaboration and teamwork
• Mastery of growth mindset (agility and developing yourself and others) skills
• Mastery of execution and delivery (planning, delivering, and supporting) skills
• Mastery of business intelligence
• Master's or PhD in Computer Science, Data Science, Biomedical Informatics, or related field

Certified Data Scientist

• Affordable medical plan options
• 401(k) plan with matching company contributions
• Employee stock purchase plan
• Wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling
• Financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access