Sr. Clinical Business Analyst

We are hiring a Sr. Clinical Business Analyst at BCBST!

In this role, you will support the Medical Policy Research & Development team by advancing medical policy operations through the use of evidence-based practices, process improvement, and AI-enabled solutions. You will help drive the development and maintenance of medical policies by conducting literature surveillance, monitoring regulatory and clinical guideline changes, and supporting interoperability and healthcare digitization initiatives. Your work will help improve operational efficiency, strengthen policy governance, and ensure timely implementation of evolving clinical and regulatory requirements.

To be successful in this role, in addition to the core job requirements, you'll bring strong analytical skills, medical policy knowledge, and experience leveraging technology to improve business processes. You will be a strong candidate for this role if you have experience with:

• Medical policy development, research, or clinical business analysis
• AI-enabled tools and technologies used to support healthcare operations
• Literature reviews, environmental scanning, and monitoring emerging clinical evidence
• Regulatory compliance, accreditation standards, and healthcare policy requirements
• Validating and quality-checking AI-generated outputs against primary source materials
• Supporting interoperability, prior authorization, and healthcare digitization initiatives
• Collaborating with cross-functional stakeholders to implement policy and operational changes
• Maintaining system configurations, policy management tools, or related operational infrastructure
• Process improvement and workflow optimization within a healthcare environment

Note:

• This is a remote role.
• Candidates should have demonstrated proficiency and comfort working with AI-enabled technologies and tools.

Job Responsibilities

• Analyze clinical, operational, and financial data to identify opportunities to improve quality, utilization, access, and service delivery.
• Lead workflow and process analysis, recommending and implementing evidence-based improvements to enhance efficiency and outcomes.
• Translate clinical and business needs into clear requirements and actionable insights in partnership with clinical, operations, IT, and analytics teams.
• Provide subject-matter expertise and education on clinical workflows, data interpretation, reporting, and system functionality.
• Ensure compliance with regulatory, accreditation, and internal governance standards related to clinical operations and data use.
• Support the evaluation, implementation, and optimization of clinical and business processes, applications, and technology-enabled solutions.
• Assess, plan, and support responsible adoption of AI initiatives, including use case evaluation, requirements definition, and performance monitoring.
• Analyze adoption, performance, and outcome data for technology solutions, identifying risks and opportunities for optimization.
• Contribute to policies, controls, and governance frameworks for the use of technology in clinical and operational environments.

Job Qualifications

Education

• Bachelor’s Degree required, or equivalent professional experience. Equivalent experience defined as 4 years of professional work experience in a healthcare, clinical operations, or corporate environment.

Licensure

• Registered Nurse (RN) with an active license in the state of Tennessee or a compact state OR Master’s-level Social Worker with an active Tennessee license (e.g., LMSW, LCSW)

Experience

• 3 years of experience in clinical operations, care management, utilization management, population health, or a comparable healthcare setting.
• 2 years of experience in reporting, data analysis, business analysis, or performance improvement.
• 1 year of experience supporting projects, initiatives, or cross-functional workgroups; project management experience preferred.
• Demonstrated experience collaborating with clinical, operational, and technical partners to improve workflows, systems, or performance outcomes.
• Experience evaluating and supporting AI-enabled or advanced analytics solutions, including understanding use cases, data inputs/outputs, limitations, and workflow impacts.

Skills & Competencies

• Strong analytical, critical thinking, and problem-solving abilities.
• Ability to translate clinical and operational needs into clear business requirements.
• Strong judgment related to risk, bias, appropriateness, and governance considerations for analytics and AI-driven tools in clinical settings.
• Proficient in Microsoft Office (Outlook, Word, Excel, Access, PowerPoint); advanced Excel skills preferred.
• Database reporting and data analysis experience.
• Ability to work independently with minimal supervision and collaboratively within a team environment.
• Proven ability to manage multiple projects, priorities, and timelines.
• Excellent oral and written communication skills, including the ability to present findings and recommendations to leadership.
• Strong interpersonal, organizational, and time-management skills.
• Comfort operating in a fast-paced, evolving environment with emerging technologies and changing priorities.

Number of Openings Available

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Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Originally posted on Himalayas