Business Analyst

Job Title: Clinical Business Analyst

Work Location: Hybrid in Eagan, MN
Job Type: 1+ year contract

About the Role:

The Clinical Business Analyst leads the design, configuration, testing, deployment, and ongoing optimization of prior authorization (PA) automation solutions utilizing MCG clinical decision support tools and Utilization Management (UM) platforms. This role serves as a key connector between clinical, operational, and technical teams to ensure PA workflows are efficient, compliant, and aligned with evidence‑based guidelines and organizational goals.

Responsibilities:

• Lead end-to-end delivery of automated prior authorization solutions within MCG and UM platforms.
• Design and document automated PA workflows, decision logic, and exception handling aligned with clinical guidelines and payer policies.
• Configure MCG rules, guidelines, and system integrations supporting automated and semi-automated decisions.
• Partner with UM operations to reduce manual review, streamline processes, and improve turnaround time.

• Gather, analyze, and document business, clinical, and functional requirements.
• Translate requirements into functional specifications, user stories, and process documentation.
• Maintain clear traceability from requirements through configuration and testing.
• Use data and clinical best practices to support solution recommendations.

• Develop and execute test strategies, cases, and validation plans for PA automation.
• Support unit, integration, UAT, and regression testing.
• Validate accuracy, compliance, and operational readiness before go‑live.

• Create training materials and deliver training to UM nurses, providers, and operational teams.
• Support go-live activities, stabilization, and ongoing optimization.
• Serve as a subject matter expert (SME) for PA automation enhancements, issues, and defect resolution.

• Collaborate with clinical leadership, UM operations, IT teams, vendors, and compliance.
• Ensure solutions meet CMS, NCQA, state regulatory, and payer policy requirements.
• Support audit readiness, documentation, and compliance activities.

Qualifications

• Bachelor’s degree in Healthcare, Nursing, Health Informatics, Business, or related field — or equivalent experience.
• 5+ years of experience as a Business Analyst in healthcare, payer operations, or health IT.
• Hands-on experience with MCG (formerly Milliman Care Guidelines).
• Strong knowledge of Utilization Management and Prior Authorization workflows.
• Experience with clinical decision support or automation solutions.
• Strong documentation skills (requirements, workflows, testing).
• Experience working in Agile, hybrid, or waterfall environments.

Preferred Qualifications

• Clinical background (RN, LPN, MD, PharmD) or significant clinical workflow experience.
• Experience with UM platforms such as Predictal, Helios, GuidingCare, TruCare, or Epic UM.
• Experience integrating PA systems with EDI, APIs, or provider portals.
• Experience with Jira or similar work management tools.

• Analytical thinking and problem-solving skills.
• Excellent written and verbal communication.
• Ability to influence and build relationships across teams.
• Detail-oriented with a focus on quality, compliance, and patient impact.

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