Senior Business Analyst - Utilization Management

Blue Cross Blue Shield of Minnesota•Eagan, MN

9d•Hybrid

About The Position

The Utilization Management Business Analyst is responsible for leading the design, documentation, configuration, testing, training, and ongoing support of prior authorization (PA) automation solutions and Utilization Management (UM) platforms. This role serves as a key liaison between clinical, operational, and technical stakeholders to ensure automated PA workflows align with evidence-based guidelines, regulatory requirements, and business objectives. The ideal candidate brings deep expertise in clinical utilization management, payer operations, and healthcare IT systems, with a proven ability to translate complex clinical and regulatory requirements into scalable, automated solutions.

Requirements

5+ years of related professional experience.
All relevant experience including work, education, transferable skills, and military experience will be considered.
Advanced collaborative, interpersonal, oral and written communication skills and demonstrated ability to develop accurate and appropriate communications.
Advanced ability to communicate to all levels of management.
Advanced research, analytical and problem solving skills.
Advanced skills in Microsoft Excel, Word, and Access.
Strong ability to make decisions based on analysis and business needs.
Advanced ability to bring a different perspective to situations and challenge the status quo.
Project management skills.
Proven ability to work independently with guidance in only the most complex situations.
High school diploma (or equivalency) and legal authorization to work in the U.S.

Nice To Haves

Bachelor's degree in Healthcare, Nursing, Health Informatics, Business, or a related field (or equivalent experience)
Clinical background (e.g., RN, LPN, MD, PharmD) or significant clinical workflow experience
Strong hands-on experience with UM automation tools
Proven experience with Utilization Management and Prior Authorization workflows
Demonstrated experience designing or supporting clinical decision support or automation solutions
Experience working in Agile, hybrid, or waterfall delivery environments
Experience integrating PA systems with EDI, APIs, or provider portals
Experience using Jira

Responsibilities

Conducts in-depth research and analysis.
Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.
Documents metrics and process changes.
Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.
Participate in and coordinate individual projects and related activities to ensure project progresses on schedule.
Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.
Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.
Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.
Serves as senior subject matter expert associated with content, processes, and procedures.
May lead project teams and may provide training to lower level staff to achieve project milestones and objectives.