Company Description Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation. Role: Lead Business Analyst (Clinical Background) Location: Reston VA - 100% Remote Job Type: Contract Job Summary: We are seeking a Lead Business Analyst (Clinical) with strong healthcare domain expertise to drive business requirements, utilization management initiatives, and end-to-end business testing. This role will work closely with business, IT, and testing teams to ensure successful delivery of clinical and prior authorization solutions aligned with regulatory mandates. Key Responsibilities: Lead business requirements gathering and documentation for clinical systems. Drive Utilization Management (UM) and Prior Authorization initiatives. Ensure end-to-end requirements traceability. Manage and support business testing and test remediation lifecycle. Collaborate with business, IT, and QA teams for project delivery. Lead RAID tracking, dependencies, and weekly project status reporting. Support provider onboarding and business readiness activities. Participate in large stakeholder meetings and drive discussions. Utilize tools like Jira for tracking and reporting. Work with PAS (Prior Authorization System) and integrated platforms. Required Qualifications: Bachelor’s degree or equivalent experience. 10+ years of experience as a Business Analyst in healthcare. Strong experience with Prior Authorization and Provider Data. Hands-on experience with Utilization Management (UM) and Clinical Operations. Clinical background with knowledge of CMS-0057F mandate. Experience with Medicare, Medicaid, and BCBSA plans. 2+ years of experience with GuidingCare or similar platforms (GIBA, Medecision). Strong experience in business testing and requirements traceability. Excellent communication and stakeholder management skills. Strong experience with Jira. Preferred Skills: Experience with DTR/MCG platform integration. Knowledge of PAS (Prior Authorization System) workflows. Experience in project management and RAID tracking. Familiarity with SDLC, test strategies, and quality assurance processes. Experience with databases and query languages. Strong analytical and problem-solving skills. Experience in Agile environments. Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.