New

Clinical Business Analyst

TEKsystems
$50.00 - $65.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, Minnesota, St. Paul
Feb 25, 2026
Description Clinical Business Analyst The Clinical Business Analyst is responsible for leading the design, documentation, configuration, testing, training, and ongoing support of prior authorization (PA) automation solutions using MCG clinical decision support tools and Utilization Management (UM) platforms. This role serves as a key liaison between clinical, operational, and technical stakeholders to ensure automated PA workflows align with evidence-based guidelines, regulatory requirements, and business objectives. The ideal candidate brings deep expertise in clinical utilization management, payer operations, and healthcare IT systems, with a proven ability to translate complex clinical and regulatory requirements into scalable, automated solutions. Key Responsibilities Prior Authorization & UM Automation Lead end-to-end analysis and implementation of prior authorization automation across MCG tools and UM platforms Design and document automated PA workflows, decision logic, and exception handling aligned with clinical guidelines and payer policies Configure MCG guidelines, rules, and integrations to support automated and semi-automated authorization decisions Partner with UM operations to optimize workflows, reduce manual review, and improve turnaround times Business Analysis & Solution Design Elicit, analyze, and document business, clinical, and functional requirements Translate requirements into detailed functional specifications, user stories, and process flows Ensure traceability between business requirements, system configuration, and testing outcomes Support solution design decisions with data, operational insights, and clinical best practices Testing & Quality Assurance Develop and execute test strategies, test cases, and validation plans for PA automation Coordinate and support unit, integration, UAT, and regression testing Validate clinical accuracy, compliance, and operational readiness prior to production release Training, Deployment & Support Create training materials and deliver training for UM nurses, providers, and operational staff Support go-live activities and provide post-implementation stabilization and optimization Act as a subject matter expert (SME) for PA automation issues, enhancements, and defect resolution Stakeholder Collaboration & Governance Collaborate with clinical leadership, UM operations, IT, vendors, and compliance teams Ensure solutions comply with CMS, NCQA, state regulations, and payer policies Support audit readiness and documentation related to prior authorization decisions Skills Business analysis, Prior Authorization, MCR tools, End to End, Prior Authorization automation, UAT Top Skills Details Business analysis,Prior Authorization,MCR tools,End to End,Prior Authorization automation,UAT Additional Skills & Qualifications Required Qualifications Bachelor's degree in Healthcare, Nursing, Health Informatics, Business, or a related field (or equivalent experience) 5+ years of experience as a Business Analyst in healthcare, payer operations, or health IT Strong hands-on experience with MCG (formerly Milliman Care Guidelines) Proven experience with Utilization Management and Prior Authorization workflows Demonstrated experience designing or supporting clinical decision support or automation solutions Strong documentation skills, including requirements, workflows, and test artifacts Experience working in Agile, hybrid, or waterfall delivery environments Preferred Qualifications Clinical experience (e.g., RN, LPN, MD, PharmD) or significant clinical workflow experience Experience with UM platforms (e.g., Predictal, Helios, GuidingCare, TruCare, Epic UM, or similar) Experience integrating PA systems with EDI, APIs, or provider portals Experience with Jira Core Competencies Clinical and operational understanding of utilization management Expertise in prior authorization policy interpretation and automation Strong analytical and problem-solving skills Excellent written and verbal communication Ability to influence without authority and manage complex stakeholder relationships Detail-oriented with a focus on quality, compliance, and patient impact Experience Level Intermediate Level Job Type & LocationThis is a Contract position based out of Saint Paul, MN. Pay and BenefitsThe pay range for this position is $50.00 - $65.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace TypeThis is a hybrid position in Saint Paul,MN. Application DeadlineThis position is anticipated to close on Mar 6, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.