Clinical Business Analyst

Clearlink Partners is an industry-leading managed care consultancy specializing in clinical and operational management services. The Clinical Business Analyst will translate clinical program needs into functional business requirements, lead workflow optimization projects, and analyze clinical data to support business decisions.

Responsibilities:

• Translate clinical program needs into functional business requirements, process maps, and workflow documentation
• Lead workflow development and optimization projects for functions such as care coordination, utilization review, and disease management
• Analyze clinical data and trends to support business decisions and regulatory compliance
• Support the implementation of new clinical systems, policies, or regulatory requirements (e.g., NCQA, CMS, HEDIS)
• Monitor and report key performance metrics related to clinical operations
• Understands business process management and business requirements of the customers and translating them to specific process, control, and reporting requirements
• Identifying areas for process improvement, and developing/ implementing solution
• Leading review and writing descriptions of business needs and business program functions, including creating process and data flow diagrams, workflow diagrams, test scripts, training curriculum, and quality assurance/audit procedures
• Identifying opportunities for workflow optimization, efficiency and automation
• Staying up-to-date on the latest process and IT advancements to automate and modernize systems
• Conducting meetings and presentations to share ideas and findings
• Performing requirements analysis
• Documenting and communicating the results
• Recommend alert and reporting requirements
• Leverage technical skills, coupled with business intelligence and a deep understanding of the customer's needs to transform information into application and operational requirements
• Effectively communicating insights and plans to cross-functional team members and management
• Gathering critical information from meetings with various stakeholders and producing useful reports
• Ensuring options are evaluated and presented to meet business needs and requirements
• Performing user acceptance testing
• Basic knowledge in generating process documentation
• Strong written and verbal communication skills including technical writing skills
• Updating, implementing, and maintaining procedures
• Prioritizing initiatives based on business needs and requirements
• Serving as a liaison between stakeholders, business units, technology teams and support teams
• Managing competing resources and priorities
• Monitoring deliverables and ensuring timely completion of projects

Requirements:

• Bachelor's degree in Healthcare Administration, Nursing, Public Health, Business, or related field (required)
• Minimum of 3 years of experience in a managed care or healthcare setting, preferably in roles involving clinical operations, utilization management, or workflow optimization
• Strong technical proficiency with Microsoft Office (Word, Excel, Visio, Outlook, PowerPoint), project tracking tools, and workflow diagramming software
• Skilled in developing and communicating complex clinical business requirements and translating them into actionable solutions
• Prior experience supporting clinical systems and workflows (e.g., Care Management Platforms, EHRs, Claims Processing)
• Ability to evaluate opportunity and determine/ present viable options/ alternatives
• Strong technical skills
• Excellent documentation skills
• Fundamental analytical and conceptual thinking skills
• Experience creating detailed reports
• Competency in Microsoft applications including Word, Excel, Project and Outlook
• Strong planning, organizational, and time management skills
• Must be able to sit in a chair for extended periods of time
• Must be able to speak so that you are able to accurately express ideas by means of the spoken word
• Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
• Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
• Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
• Must be able to fluently communicate both verbally and in writing using the English language
• Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously
• A bachelor's degree in business or related field preferred, comparable experience considered
• Familiarity with HEDIS, NCQA, CMS regulations, or other clinical quality standards is highly desirable
• Experience with Jiva, GuidingCare and Aerial systems
• Previous experience working for a managed care organization in Claims, Business / Systems Analysis or Quality Assurance
• Experience in analyzing data to draw business-relevant conclusions and in data visualization techniques and tools