Business Analyst

Skills

Bachelor's degree in business or related area of study or equivalent combination of education and/or relevant work experience; HS diploma or GED is required 2 years of work experience in the PBM or healthcare industry Must be eligible to work in the United States without the need for work visa or residency sponsorship. Additional Qualifications Demonstrated proficiency in basic office productivity software and tools (MS Word Excel One Note One Drive Outlook Teams etc.) Strong Organizational analytical and interpretive skills Strong verbal and written communication skills Ability to self-motivate and work with minimal supervision with a high level of accountability Strong problem-solving skills that include research and utilizing resources Ability to work under strict timelines while managing multiple priorities simultaneously

Description

The Clinical Decision Configuration Analyst is responsible for configuration of clinical pharmacy prior authorization (PA) criteria, business rules, program assignments and correspondence in the decision management and contact management applications for all lines of business.

Responsibilities

• Configure appropriate tables and settings in the decision management and contact management applications; complete content build and revisions related to criteria and fax form intake requests to ensure review tools are available when expected
• Identify areas for improvement to prevent quality issues from recurring
• Analyze requests, develop and validate plans including assessment of relevant formulary data and/or Utilization Management (UM) policy for automation opportunity and potential impacts on tool performance and maintenance requirements
• Execute peer reviews or other quality measures to ensure all clinical review criteria and/or correspondence tools meet high quality standards and prevent quality issues from reoccurring; partner with internal teams (i.e., Testing, Training, Contact Center, Account Management) to research any discrepancies identified
• Provide support and educate internal partners (i.e., Clinical Call Center, Utilization Management, Service Delivery etc.) on appropriate use of the tools
• Other duties as assigned