Summary
Overview
Work History
Education
Skills
Certification
Affiliations
Publications
Accomplishments
Languages
References
Timeline
Generic

Sudha KishoreKumar

Oviedo

Summary

Healthcare Analytics Leader with extensive experience in leading cross-functional teams and executing complex projects. Demonstrated ability to foster a collaborative work environment through effective mentorship and partnership. Skilled in integrating business insights with analytical and technical expertise to create impactful solutions. Proven success in managing stakeholder relationships across clinical, technical, and executive levels in dynamic settings.

Overview

17
17
years of professional experience
1
1
Certification

Work History

Principal Data Scientist

United Health Group
01.2024 - Current
  • Lead analytics efforts to support Medicare Part C hospital quality measures, focusing on improving follow-up rates after inpatient and emergency room visits and reducing readmissions.
  • Collaborate with hospital measure owners and clinical stakeholders to design data-driven strategies that improve performance on key hospital-based HEDIS metrics.
  • Develop and maintain machine learning models to predict member risk and performance trends for hospital-related measures; models are operationalized using Apache Airflow for automation and scalability.
  • Design and implement member prioritization algorithms to optimize outreach and care coordination efforts.
  • Conduct advanced analyses to identify barriers and opportunities and translate insights into actionable strategies that drive improvements in hospital measure rates.

Sr. Manager, Data & Insights

CVS HEALTH CORPORATION
06.2023 - 12.2023
  • Analyze data from diverse sources to productize and monetize enterprise data and insight for internal and external customers, including pharmaceutical manufacturers and payors.
  • Engage in requirements elicitation meetings to brainstorm ideas to design delivery strategy of data and insight products.
  • Performed data profiling on 66% of abandoned prescriptions to enable interventions to improve medication adherence rates.

Lead Data Scientist

CVS HEALTH CORPORATION
11.2021 - 06.2023
  • Design and analyze raw data to create longitudinal analytic datasets to cater to RWE project requirements.
  • Uses advanced programming in SAS and Python to create complex algorithms and data visualization using Tableau and Microsoft Power BI to illuminate therapeutic and economic value to stakeholders' organization.
  • Responsible for sharing results and status of research during internal and external weekly meetings and preparing the final report to furnish findings of research.
  • Leading RWE feasibility studies which involve understanding feasibility questions to determine clinical logic.
  • Work closely with medical directors to finalize the clinical code set.
  • Leading GCP Migration project for CTS RWE team that involves interacting with solution architects, solution engineers, and GCP migration project management team on the design and configuration of GCP tenant.
  • Member of the core technical committee overseeing CVS & Aetna analytics.
  • Created technical interview & onboarding process; interviewed & onboarded many data scientists/analysts.
  • Designs data integrity documents (e.g., DMP, Validation Plan, Data Migration) and protocol amendments with Clinical Operations and client.
  • Manages a team of 3 junior data scientists; guides data analysis and validation plans; advises on data best practices.

Sr. Manager, Informatics

CVS HEALTH CORPORATION
07.2018 - 11.2021
  • Analyze, Design, and Develop reporting solutions utilizing SAS, Tableau, Power BI, Hadoop, DB2 SQL, Alteryx, SSIS, and MS SQL against Enterprise data warehouse, Provider Reporting database, Utilization/Case management applications for regulatory entities.
  • Implemented process improvement strategies in the generation of CMS Medicare Universe that resulted in a decrease of production time by up to 70% during internal and CMS quality/program audits.
  • Mentored and Managed regulatory resources on crucial project initiatives by performing code reviews, offering technical assistance and guidance, and being the point of contact for project status.
  • Responsible for Medicare pre-service OD Compliance reporting from Utilization management applications.
  • Implemented audit tool to identify errors in clinicians/MDs workflow to ensure accurate reporting of ODs to CMS.
  • Responsible for summarizing data from all applications before CMS submission.
  • Represent regulatory reporting team in CMS HPMS audit.
  • Migrated Medical /Accreditation membership reports from Excel to the Power BI dashboard.
  • Responsible for submission of QHP and Commercial/Medicare membership in NCQA HOQ annually.
  • Migrated approximately about 25 Medical and BH Regulatory reports from MS Access to SAS.
  • Support HEDIS initiatives by executing member mailings annually on those with gaps in HEDIS measures.
  • Provide a list of providers not abiding by NCQA standards to the Provider outreach team for continuous education on standards.

Clinical Informatics Analyst

Capital District Physicians Health Plan
08.2008 - 06.2018
  • Develop analytical and reporting solutions utilizing SAS, Oracle, Tableau, Cognos, R, Python, SSIS, SSRS, MYSQL, and MS SQL against Enterprise data warehouse, Facets Reporting database, and CAE reporting database.
  • Technical Lead for HEDIS.
  • Developed ETL processes to create HEDIS extracts for Inovalon, HEDIS Vendor.
  • Planned, Designed, Developed, and Implemented Medicaid PIP Perinatal Measures for 17-P and contraceptive care measures.
  • Responsible for Release Management activities – Release Planning, Release Building, User Acceptance Testing, Release Preparation and Deployment.
  • Planned, Designed, Developed, and Implemented a metadata layer for Enterprise Data Warehouse.
  • Developed Cognos Reporting and Framework coding standards for BI Analysts/Developers.
  • Involved in preparing materials and training Cognos Business Authors.
  • Understand the CAE CCA database and map it to business requirements to identify data elements for migration into the Enterprise data warehouse for a Person-centric data mart.

Education

Ph.D. - Big Data Analytics

University of Central Florida
Charlotte, NC
07.2025

Master of Science - Data science and Business Analytics

University of North Carolina At Charlotte (UNCC)
Charlotte, NC
05.2020

Skills

  • Base SAS
  • SAS Enterprise Guide
  • Python
  • R
  • R Studio
  • R Shiny
  • Tableau
  • Power BI
  • IBM Cognos 8 & 10
  • Crystal Reports
  • SSRS
  • SSIS
  • Oracle
  • Microsoft SQL Server
  • GCP/Big Query
  • SQL
  • Hive
  • MongoDB
  • Snowflake
  • Hadoop
  • Teradata
  • JavaScript
  • VB Script
  • Java
  • Microsoft Visual Basic
  • Microsoft Azure
  • Project Management
  • Requirements Gathering
  • Tidal
  • Windows Scheduler
  • Apache Airflow
  • Salesforce
  • QuickBase
  • MS Access
  • MS Excel

Certification

  • PMI Certified Project Management Professional
  • Google Certified – Cloud Digital Leader
  • IBM Certified Cognos 8 BI, Cognos 10 BI - Administrator, Designer, Metadata Developer
  • SAS Certified Base Programmer for SAS 9
  • SAS Certified Advanced Programmer for SAS 9

Affiliations

  • Project Management Institute
  • Toastmasters
  • Blue Circle Leadership
  • Enterprise Mentoring Program

Publications

  • Insulin pen needle fill rates among insured adults with type 1 and type 2 diabetes in the US, 2019-2021: a retrospective claims analysis, Ray Sieradzan, Andrew Thach, Pasha Javadi, Laura Lupton, Xiaowu Sun, Joaquim Fernandes, Sudha Kishorekumar, 2023-10-01, AMCP Nexus Meeting, Orlando
  • How to use a prompt for connecting the same package to different databases and displaying the name of the database in the Cognos reports, 2009-01-01, IBM Cognos Support site

Accomplishments

  • Received diamond award for performance, collaboration and quality
  • Mulitiple awards for exhnibiting core values in CVS health
  • Received multiple commitment and accountability award in CDPHP

Languages

English
Full Professional
Tamil
Limited
Telugu
Limited

References

References available upon request.

Timeline

Principal Data Scientist

United Health Group
01.2024 - Current

Sr. Manager, Data & Insights

CVS HEALTH CORPORATION
06.2023 - 12.2023

Lead Data Scientist

CVS HEALTH CORPORATION
11.2021 - 06.2023

Sr. Manager, Informatics

CVS HEALTH CORPORATION
07.2018 - 11.2021

Clinical Informatics Analyst

Capital District Physicians Health Plan
08.2008 - 06.2018

Ph.D. - Big Data Analytics

University of Central Florida

Master of Science - Data science and Business Analytics

University of North Carolina At Charlotte (UNCC)

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Sudha KishoreKumar