Business Analyst - Health Plan (Clinical Space)

Pinnacle Method Consulting's mission is to help job seekers reach their career peak by accessing top-tier opportunities. We are not a staffing firm or agency. Pinnacle Method does not hire for these roles—we systematically source and verify them from premier employers.

Business Analyst - Health Plan (Clinical Space)

Remote

We are looking for an experienced Business Analyst with a strong background in Health Plans and Clinical Operations. The ideal candidate should have expertise in Clinical Policy, Care Management, Utilization Management, and Electronic Health Records (EHRs).

Key Responsibilities

• Work with stakeholders to gather and document business, functional, and non-functional requirements.
• Support Care Management processes such as Assessments, Stratification, and Letters.
• Assist in Utilization Management, including Prior Authorization, Turnaround Times, and Policies.
• Work with HealthEdge's Guiding Care system and Electronic Health Records (EHRs).
• Create process flows, diagrams, and traceability matrices.
• Manage requirements using Azure DevOps (ADO).
• Collaborate with teams to build UAT scenarios and support Agile delivery.
• Assist in project planning, status reporting, and change management.
• Escalate risks and issues to the Project Manager.

Qualifications

• 10 years of experience as a Business Analyst in Health Plans/Clinical Space.
• Knowledge of Care Management, Utilization Management, and Clinical Policy.
• Experience with Azure DevOps (ADO) and Agile methodologies.
• Strong communication and stakeholder management skills.

#PinnacleMethodConsulting