Business Analyst Sr, Clinical Operations

CalOptima is a mission-driven community-based organization focused on serving member health with excellence and dignity. They are seeking a Business Analyst Sr for Clinical Operations to support the MM - Utilization / Case Management team by translating complex business needs into actionable analytical and reporting solutions, while ensuring compliance and alignment with organizational goals.

Responsibilities:

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department
• Provides analytical support and expertise on requests for information from executives, directors and other staff regarding claims, authorization and enrollment data
• Acts as a liaison between Clinical Operations business owners and reporting teams
• Supports cross functional reporting initiatives in conjunction with the Clinical Operations teams, Information Technology and Financial Analysis to implement reports that support regulatory requests, business operations and program outcomes
• Creates comprehensive business user test scenarios and testing schedules, including time estimates and deadlines, monitors milestone completion, tracks all phases of testing and provides timely reporting of issues that impact the testing progress
• Conducts system research and testing to ensure reports produce expected results, maintains version control to ensure that all report documentation accurately reflects the current status, including changes and issues identified during testing
• Monitors report usage and effectiveness post-deployment to ensure the ongoing needs of the business are met
• Monitors the use of metric definitions and reports to ensure consistency across reports and dashboards
• Maintains core competency in Clinical Operations programs and organizational operations, including staying current on program design, program requirements and operational changes
• Collaborates with Clinical Operations leadership and program team, configuration and training to ensure alignment across all aspects of the process, including system design, process adherence, operational desktop procedures and CalOptima Health policies and procedures
• Notifies Clinical Operations leadership of the impacts on reporting and processes or of changes that affect business operations that depend on reports, including process deficiencies identified through analysis and user acceptance testing (UAT)
• Remains updated on state, federal and commercial health care environments, identifying impacts to CalOptima Health programs and Clinical Operations by monitoring resources such as Centers for Medicare & Medicaid Services (CMS) Updates, Medi-Cal Provider Bulletins, Medi-Cal manuals and Industry Collaboration Effort (ICE)
• Facilitates communication on report-related topics
• Reviews ad-hoc analysis and generates reports as requested
• Completes other projects and duties as assigned

Requirements:

• Bachelor's degree in business administration, management, data science or related field PLUS 3 years of experience supporting clinical reporting, gathering business requirements, and executing reports in a managed care plan required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying
• Experience with case management and/or utilization management data, clinical systems and processes
• Experience with meeting regulations from CMS, Department of Health Care Services (DHCS) and/or Department of Managed Health Care (DMHC)