Analyst III - Business Support Clinical
About The Position
The Analyst III - Business Support Clinical works within precedents, well-defined policy, and supervisory review. The role sets its own priorities and may depart from established procedures when results meet standards of acceptability. The analyst researches, analyzes, maintains, modifies, validates, and prepares business data and content used for decision-making, presenting findings and explaining results. The position also monitors and tests systems and processes, assesses the effectiveness of solutions and policies, and recommends improvements to support service quality, compliance, and continuous improvement. The analyst produces business documents and delivers or facilitates internal meetings, webinars, training, education, and certification sessions. The role participates in or leads departmental projects and workgroups, and builds internal partnerships to improve coordination and collaboration. The position has a hybrid work arrangement combining flexibility with in-office engagement; schedules depend on role requirements and business needs, and travel to corporate or regional offices may be required.
Requirements
- At least 3 years of related work experience.
- A related bachelor’s degree or additional related equivalent work experience.
Nice To Haves
- Understanding of healthcare regulations, such as CMS and NCQA.
- Knowledge of utilization management processes, prior authorization workflows, and regulatory reporting standards.
- Experience with CMS-0057F Prior Auth Metrics and NCQA reporting and preparation.
- Familiarity with quality metrics and value-based care initiatives.
- Experience with clinical systems such as UM Prior Authorizations, Grievance & Appeals, Care Management, or EMR, including MCG, MC400, and MHK.
- Experience with data analytics tools and visualization software.
- Ability to learn and adapt to new healthcare technologies and software applications.
- Ability to serve as a clinical data resource expert and trusted advisor to UM leadership and stakeholders.
- Ability to educate interdisciplinary teams on clinical data reporting, information extraction, and system workflows.
- Ability to translate clinical needs into technical solutions.
- Healthcare domain expertise and understanding of clinical work and processes.
- Ability to combine clinical knowledge and analytical skills to bridge communication between technical teams and clinical stakeholders.
Responsibilities
- Research, analyze, maintain, modify, validate, and prepare data, information, and content used for business decisions; present findings and articulate results.
- Monitor, maintain, and test company systems that manage business and work processes.
- Monitor and evaluate solutions, policies, practices, and processes for effectiveness, continuous improvement, client relations, compliance, and adherence to business and system requirements; recommend improvements.
- Produce, edit, and distribute business documents, including reports and system and process documentation.
- Create, present, and/or facilitate meetings, webinars, conference calls, training programs, education sessions, and certifications, primarily for internal audiences.
- Participate in or lead smaller departmental projects or project components; project activities may include planning, organizing, monitoring, and controlling resources and ensuring adherence to project management standards and reporting requirements.
- Participate in and/or lead department or divisional workgroups and initiatives.
- Develop internal partnerships to improve communication, coordination, collaboration, and working relationships within the department.
Benefits
- Medical, dental, vision, life, and global travel health insurance.
- Income protection benefits, including life insurance and short- and long-term disability programs.
- Leave programs to support personal circumstances.
- Retirement Savings Plan with employer match.
- Paid time off, volunteer time off, 10 holidays, and 2 well-being days.
- Additional voluntary benefits.
- Comprehensive wellness program.
- Competitive pay and opportunities for incentive or commission compensation.
- Annual reviews with pay-for-performance considerations for base pay increases.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
