Clinical Business Analyst (Compact RN License)

Company Description

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.

We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Position Responsibilities

Specific

• Translate clinical program needs into functional business requirements, process maps, and workflow documentation.
• Lead workflow development and optimization projects for functions such as care coordination, utilization review, and disease management.
• Analyze clinical data and trends to support business decisions and regulatory compliance.
• Support the implementation of new clinical systems, policies, or regulatory requirements (e.g., NCQA, CMS, HEDIS).
• Monitor and report key performance metrics related to clinical operations.
  
  

General

• Understands business process management and business requirements of the customers and translating them to specific process, control, and reporting requirements
• Identifying areas for process improvement, and developing/ implementing solution
• Leading review and writing descriptions of business needs and business program functions, including creating process and data flow diagrams, workflow diagrams, test scripts, training curriculum, and quality assurance/audit procedures.
• Identifying opportunities for workflow optimization, efficiency and automation
• Staying up-to-date on the latest process and IT advancements to automate and modernize systems
• Conducting meetings and presentations to share ideas and findings
• Performing requirements analysis
• Documenting and communicating the results
• Recommend alert and reporting requirements
• Leverage technical skills, coupled with business intelligence and a deep understanding of the customer's needs to transform information into application and operational requirements
• Effectively communicating insights and plans to cross-functional team members and management
• Gathering critical information from meetings with various stakeholders and producing useful reports
• Ensuring options are evaluated and presented to meet business needs and requirements
• Performing user acceptance testing
• Basic knowledge in generating process documentation
• Strong written and verbal communication skills including technical writing skills
• Updating, implementing, and maintaining procedures
• Prioritizing initiatives based on business needs and requirements
• Serving as a liaison between stakeholders, business units, technology teams and support teams
• Managing competing resources and priorities
• Monitoring deliverables and ensuring timely completion of projects
  
  

Position Qualifications:

Competencies

• Strong technical proficiency with Microsoft Office (Word, Excel, Visio, Outlook, PowerPoint), project tracking tools, and workflow diagramming software.
• Skilled in developing and communicating complex clinical business requirements and translating them into actionable solutions.
• Bachelor’s degree in Healthcare Administration, Nursing, Public Health, Business, or related field (required).
• Current unencumbered compact RN license
• Experience with Jiva, GuidingCare and Aerial systems
• Minimum of 3 years of experience in a managed care or healthcare setting, preferably in roles involving clinical operations, utilization management, or workflow optimization.
• Prior experience supporting clinical systems and workflows (e.g., Care Management Platforms, EHRs, Claims Processing).
• Familiarity with HEDIS, NCQA, CMS regulations, or other clinical quality standards is highly desirable.
• Ability to evaluate opportunity and determine/ present viable options/ alternatives
• Strong technical skills.
• Excellent documentation skills
• Fundamental analytical and conceptual thinking skills
• Experience creating detailed reports
• Competency in Microsoft applications including Word, Excel, Project and Outlook
• Strong planning, organizational, and time management skills.
  
  

Experience

• A bachelor’s degree in business or related field preferred, comparable experience considered
• A minimum of 3 years as a team member on process-oriented projects in highly complex business-to-business and/or outsourced client environments
• Previous experience working for a managed care organization in Claims, Business / Systems Analysis or Quality Assurance
• Proven experience in eliciting requirements and testing
• Experience in analyzing data to draw business-relevant conclusions and in data visualization techniques and tools
• A history of supporting successful projects
  
  

Physical Requirements

• Must be able to sit in a chair for extended periods of time
• Must be able to speak so that you are able to accurately express ideas by means of the spoken word
• Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
• Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
• Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
• Must be able to fluently communicate both verbally and in writing using the English language
• Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously
  
  

Time Zone: Mountain or Pacific (preferred)

Other Information

• Expected Hours of Work: Friday 8am – 5 pm; with ability to adjust to Client schedules as needed
• Travel: May be required, as needed by Client
• Direct Reports: None
• Salary Range: $100,000 - $160,000
  
  

EEO Statement

It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.