Business Analyst Medical and Care Management (Hybrid/Remote)
The Business Operations Analyst – Medical Management will report to the Senior Director of Operational Excellence and Business Analytics and directly support the business units which comprise the Medical Management Department; Care Management, Utilization Management, Behavioral Health Services and Pharmacy Services. This role will coordinate the analysis of the current operating environment and identify areas for improvement using a data driven approach to inform business decisions. The ideal candidate will have strong technical, analytical, and presentation skills, in addition to strong communication skills and the ability to effectively liaison between IT and Operations. Medicaid Managed Care experience, Health Plan Operations experience, business acumen and attention to detail are important to the success of this role. If you thrive in a mission-driven, enrollee focused environment, and have interest in improving quality health outcomes, this role is for you.
The analyst role is a hybrid work schedule with an option to work remotely.
High School Diploma or GED (Required)
Bachelor’s Degree (Preferred) Or
Minimum Work Experience
3 years Business operations, analytics, corporate strategy, or other relevant experience (Required)
3 years Medicaid Managed Care of Health Plan Operations experience (Required)
3 years Aligning multiple cross-functional teams and achieving unified outcomes (Required)
Advanced proficiency with SQL, Excel and Microsoft Applications
Experience with Trizetto QNXT data architecture is a plus
Data-driven, highly motivated and detail oriented
Strong business analytical skills
Ability to develop and clearly document business requirements
Ability to assess risks and assumptions which will inform strategic decisions
Strong oral and written communication skills, with the ability to present actionable insights
Ability to prioritize and balance multiple projects and priorities
Ability to effectively gather data from various sources for reporting, and presentation
Ability to manage relationships with internal stakeholders and hold others accountable to timelines and objectives
Experience with claims data i.e., CPT, HCPCS, ICD-10, standard medical terminology
Health Plan Operations expertise with Medicaid Managed Care experience a plus
Provide timely and accurate access to data, distribute reports and present/explain results to business units supported by this role.
Participate in the business requirements gathering and documentation to support departmental and organization wide projects.
Collaborate with business leaders and department SMEs to design and implement feedback mechanisms to gather ongoing changes in business processes.
Analyze operational performance for applicable business units and create plans to address opportunities for improvement.
Develop and maintain tools to measure operational performance for applicable business units against benchmarks.
Use various analysis techniques such as use-case analysis, workflow analysis, functional analysis, financial modeling, and others to support initiatives.
Support business areas with systems and applications implementations.
Perform work related to ad-hoc special projects requested by business departments leaders.
Protect sensitive and confidential data in conducting business and operational analysis.
Collaborate with configuration, data, and reporting teams within the IT department.
Other duties as assigned.
DC RESIDENTS ENCOURAGED TO APPLY