Job Summary - Business Analyst III UM/CM

The Business Analyst III acts as the primary liaison between IT and the operational departments within the

organization. This position functions in a trusted advisor role. It provides subject matter expertise to the clients

in which it serves through analysis and the development of business and functional requirements for initiatives

of all sizes. The Senior Business Analyst serves in a relationship management role to increase customer

service, and participates on project teams to assist in timely delivery of IT project initiatives. This role also

serves as a mentor to team members.

This position will primarily support the Quality Health Care Management area of the organization including

Utilization Management, Care Management (Case & Disease), Behavioral Health and Pharmacy.

Responsibilities

Serves as technical and process expert for initiatives involving Quality Health Care Management

Leads and guides workgroups through the evaluation of current state processes. Performs analysis to

define opportunities to create improved future state processes (end-to-end process flow development)

Conducts analysis of business and user's needs and forecasted outcomes to achieve system redesign process

alternatives

Assists management and end users in evaluating vendor software applications.

Partners with functional leads to ensure consistency, coordination, and integration of design activity within

functions (e.g., UM, case management, disease management, pharmacy, IT.) that support the strategic goals

of Quality Health Care Management

Leads and facilitates requirements and design sessions to identify specifications for system changes

Documents business and functional specifications used for software design and development including

software traceability matrices and use case diagrams.

Conducts requirements reviews to obtain sign-off from project/operational stakeholders.

Sets projects timelines with identified deliverables. Creates task lists/project plans for smaller initiatives.

On larger project initiatives completes assignments as defined by the Project Team.

Reports project status updates to stakeholders inclusive of successes, barriers, and identified challenges

Identifies issues and facilitates problem resolution for manual, batch and online environments. Ability to

interrogate error codes

Uses metrics and data to lead process improvement initiatives

Analyzes and queries data; has knowledge of the Facets and Clinical Care Advance data models

Data mapping, including the creation of file specifications; source to target mapping

Testing, including the creation of test scenarios, test data and understanding of outcomes

Mentors customers and peers

Communicates internally and externally with all levels of employees including senior management

Interacts with all areas of Information Technology as well as software vendors

End-to-end ownership of assigned initiatives – requirements through implementation

Keeps current with industry trends and state/federal compliance initiatives

Participates in user groups

Qualifications

BA/BS - Bachelors Degree or equivalent required. Degree in Computer Science or Computer

Programming a plus

Minimum 5-8 years previous experience as a Business/Systems Analyst

Health Care Industry experience

Knowledge of Medicare, Medicaid, Commercial and Managed Long Term Care programs

Previous experience with utilization management, care management systems and operational workflows.

Experience with TriZetto Facets Utilization Management system and Clinical Care Advance applications a

plus

Proficiency with SQL (querying, analyzing and mapping data)

Demonstrated ability to ..

o Lead and elicit business needs and requirements from a diverse set of stakeholders

o Document and communicate requirements to the stakeholders, developers and testers.

o Construct or modify use case diagrams and process models.

o Create and execute test scenarios

Experienced in full software development life cycle

Understanding of the concept of online and batch environments

Excellent PC skills utilizing Microsoft Office software (Excel, Word, Visio, PowerPoint, and Access)

Proven problem solving and analytical skills

Detail oriented with the ability to manage multiple tasks simultaneously

Excellent organization and follow through skills

Excellent interpersonal, written and verbal communication skills

Ability to build and maintain good rapport with internal and external customers and handle situations with

confidence, tact and resourcefulness

Flexible, adaptable with the ability to work under pressure to meet deadlines in a fast paced environment

Strong team player