Senior Clinical Business Analyst

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Assist the Medical Policy Research & Development team in enhancing medical policy operations through evidence-based methodologies, process enhancements, and AI-driven solutions.

• Facilitate the creation and upkeep of medical policies by conducting literature surveillance, monitoring regulatory and clinical guidelines, and supporting interoperability and healthcare digitization efforts.

• Evaluate clinical, operational, and financial data to pinpoint opportunities for improving quality, utilization, access, and service delivery.

• Oversee workflow and process evaluations, proposing and enacting evidence-based enhancements.

• Convert clinical and business requirements into actionable insights in collaboration with clinical, operations, IT, and analytics teams.

• Offer subject-matter expertise and training on clinical workflows, data interpretation, reporting, and system functionalities.

• Ensure adherence to regulatory, accreditation, and internal governance standards.

• Aid in the assessment, implementation, and optimization of clinical and business processes, applications, and technology-enabled solutions.

• Evaluate, plan, and assist in the responsible adoption of AI initiatives, including use case assessment, requirement definition, and performance monitoring.

• Analyze the adoption, performance, and outcome data of technology solutions.

• Contribute to the formulation of policies, controls, and governance frameworks for the use of technology in clinical and operational settings.

⛳️ Requirements

• Bachelor’s Degree is required, or an equivalent level of professional experience.

• Equivalent experience is defined as 4 years of professional work in a healthcare, clinical operations, or corporate setting.

• Registered Nurse (RN) with an active license in the state of Tennessee or a compact state OR Master’s-level Social Worker with an active Tennessee license (e.g., LMSW, LCSW).

• Minimum of 3 years of experience in clinical operations, care management, utilization management, population health, or a similar healthcare environment.

• At least 2 years of experience in reporting, data analysis, business analysis, or performance improvement.

• One year of experience in supporting projects, initiatives, or cross-functional workgroups.

• Proven experience collaborating with clinical, operational, and technical partners to enhance workflows, systems, or performance outcomes.

• Experience in evaluating and supporting AI-enabled or advanced analytics solutions.

• Strong analytical, critical thinking, and problem-solving skills.

• Ability to convert clinical and operational needs into precise business requirements.

• Strong judgment related to risks, biases, appropriateness, and governance considerations for analytics and AI-driven tools in clinical environments.

• Proficient in Microsoft Office (Outlook, Word, Excel, Access, PowerPoint).

• Experience in database reporting and data analysis.

• Capability to work independently and collaboratively within a team setting.

• Demonstrated ability to manage multiple projects, priorities, and deadlines.

• Excellent oral and written communication abilities.

• Strong interpersonal, organizational, and time-management skills.

• Comfort operating in a fast-paced, evolving environment with emerging technologies and shifting priorities.

• Proven proficiency and comfort working with AI-enabled technologies and tools.

🏝️ Benefits

• Remote work arrangement.

• Employee position.

• Equal employment opportunity and nondiscrimination protections.