Business Analyst Analyze and document current Utilization Management and Case Management workflows, identifying gaps and opportunities for improvement. Collaborate with clinical, operational, and IT teams to gather and validate business requirements. Translate business needs into functional specifications for system enhancements or recent implementations.
Support the design and deployment of digital solutions that streamline prior authorization, care planning, and member engagement. Conduct impact analysis and support change management initiatives across UM and Case Management functions. Develop and maintain process maps, user stories, and test cases.
Monitor KPIs and performance metrics to assess workflow efficiency and compliance. Ensure alignment with regulatory requirements (e.g., NCQA, CMS, HIPAA). 5-7 years of experience as a Business Analyst in healthcare,
insurance, or managed care settings. Strong understanding of Utilization Management and Case Management processes and systems.
Experience with workflow tools, EHR/EMR platforms, or care management systems. Proficiency in business analysis tools (e.g., JIRA, Confluence, Visio). Excellent communication, documentation, and stakeholder engagement skills.
Experience with platforms like InterQual, MCG, or CareAdvance. Familiarity with value-based care models and population health strategies.
Certification in Business Analysis (CBAP, PMI-PBA) or Healthcare IT (e.g., CPHIMS).
Experience working in Agile or hybrid project environments.