Business Analyst Sr, Clinical Operations
CalOptima, Orange, CA, United States
Business Analyst Sr, Clinical Operations
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a
Business Analyst Sr, Clinical Operations
and help shape the future of healthcare where you'll be an integral part of our
MM - Utilization / Case Management
team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be
Full Telework .
If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Business Analyst Sr will support Clinical Operations by translating complex business needs into actionable analytical and reporting solutions. You will lead the full lifecycle of reporting and data analysis, including requirements gathering, testing, solution design, validation, deployment and post-implementation evaluation. You will apply analytical expertise to evaluate business processes, identify opportunities, ensure reporting accuracy, compliance and alignment with organizational goals. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team
90% - Business Support
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Provides analytical support and expertise on requests for information from executives, directors and other staff regarding claims, authorization and enrollment data.
Acts as a liaison between Clinical Operations business owners and reporting teams.
Supports cross functional reporting initiatives in conjunction with the Clinical Operations teams, Information Technology and Financial Analysis to implement reports that support regulatory requests, business operations and program outcomes.
Creates comprehensive business user test scenarios and testing schedules, including time estimates and deadlines, monitors milestone completion, tracks all phases of testing and provides timely reporting of issues that impact the testing progress.
Conducts system research and testing to ensure reports produce expected results, maintains version control to ensure that all report documentation accurately reflects the current status, including changes and issues identified during testing.
Monitors report usage and effectiveness post-deployment to ensure the ongoing needs of the business are met.
Monitors the use of metric definitions and reports to ensure consistency across reports and dashboards.
Maintains core competency in Clinical Operations programs and organizational operations, including staying current on program design, program requirements and operational changes.
Collates clinical operations leadership and program team configuration and training to ensure alignment across all aspects of the process, including system design, process adherence, operational desktop procedures and CalOptima Health policies and procedures.
Notifies Clinical Operations leadership of the impacts on reporting and processes or of changes that affect business operations that depend on reports, including process deficiencies identified through analysis and user acceptance testing (UAT).
Remains updated on state, federal and commercial health care environments, identifying impacts to CalOptima Health programs and Clinical Operations by monitoring resources such as Centers for Medicare & Medicaid Services (CMS) Updates, Medi-Cal Provider Bulletins, Medi-Cal manuals and Industry Collaboration Effort (ICE).
Facilitates communication on report-related topics.
Reviews ad-hoc analysis and generates reports as requested.
10% - Other
Completes other projects and duties as assigned.
Do You Have What the Role Requires?
Bachelor's degree in business administration, management, data science or related field PLUS 3 years of experience supporting clinical reporting, gathering business requirements, and executing reports in a managed care plan required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
You’ll Stand Out More If You Possess the Following
Experience with case management and/or utilization management data, clinical systems and processes.
Experience with meeting regulations from CMS, Department of Health Care Services (DHCS) and/or Department of Managed Health Care (DMHC).
Your Knowledge & Abilities to Bring to this Role
Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations)
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
You’ll enjoy competitive compensation for this role.
Our current hiring range is: Pay Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947).
The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
This position is approved for Full Telework (If the position is Telework, it is eligible in California only).
CalPERS pension program and additional retirement packages.
Additional benefits and perks include:
A generous PTO program
A quality work life balance
Various wellness programs
Tuition Reimbursement
Professional development opportunities
Career development opportunities
Flexible scheduling
And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.
Our Work Environment
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
If located at the 500, 505 Building or a remote work location:
No harmful environmental conditions present for this job.
The noise level in this work environment is usually moderate.
If located at PACE:
Work is typically indoors in a clinical setting serving the frail and elderly.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
If located in the Community:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
Employee will occasionally work outdoors in varied temperatures.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
Why Join Us?
We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
#J-18808-Ljbffr
CalOptima
Join Us in this Amazing Opportunity
The Team You'll Join
We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.
More About the Opportunity
We are hoping you will join us as a
Business Analyst Sr, Clinical Operations
and help shape the future of healthcare where you'll be an integral part of our
MM - Utilization / Case Management
team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be
Full Telework .
If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.
The Business Analyst Sr will support Clinical Operations by translating complex business needs into actionable analytical and reporting solutions. You will lead the full lifecycle of reporting and data analysis, including requirements gathering, testing, solution design, validation, deployment and post-implementation evaluation. You will apply analytical expertise to evaluate business processes, identify opportunities, ensure reporting accuracy, compliance and alignment with organizational goals. Together, we are building a stronger, more equitable health system.
Your Contributions To the Team
90% - Business Support
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Provides analytical support and expertise on requests for information from executives, directors and other staff regarding claims, authorization and enrollment data.
Acts as a liaison between Clinical Operations business owners and reporting teams.
Supports cross functional reporting initiatives in conjunction with the Clinical Operations teams, Information Technology and Financial Analysis to implement reports that support regulatory requests, business operations and program outcomes.
Creates comprehensive business user test scenarios and testing schedules, including time estimates and deadlines, monitors milestone completion, tracks all phases of testing and provides timely reporting of issues that impact the testing progress.
Conducts system research and testing to ensure reports produce expected results, maintains version control to ensure that all report documentation accurately reflects the current status, including changes and issues identified during testing.
Monitors report usage and effectiveness post-deployment to ensure the ongoing needs of the business are met.
Monitors the use of metric definitions and reports to ensure consistency across reports and dashboards.
Maintains core competency in Clinical Operations programs and organizational operations, including staying current on program design, program requirements and operational changes.
Collates clinical operations leadership and program team configuration and training to ensure alignment across all aspects of the process, including system design, process adherence, operational desktop procedures and CalOptima Health policies and procedures.
Notifies Clinical Operations leadership of the impacts on reporting and processes or of changes that affect business operations that depend on reports, including process deficiencies identified through analysis and user acceptance testing (UAT).
Remains updated on state, federal and commercial health care environments, identifying impacts to CalOptima Health programs and Clinical Operations by monitoring resources such as Centers for Medicare & Medicaid Services (CMS) Updates, Medi-Cal Provider Bulletins, Medi-Cal manuals and Industry Collaboration Effort (ICE).
Facilitates communication on report-related topics.
Reviews ad-hoc analysis and generates reports as requested.
10% - Other
Completes other projects and duties as assigned.
Do You Have What the Role Requires?
Bachelor's degree in business administration, management, data science or related field PLUS 3 years of experience supporting clinical reporting, gathering business requirements, and executing reports in a managed care plan required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
You’ll Stand Out More If You Possess the Following
Experience with case management and/or utilization management data, clinical systems and processes.
Experience with meeting regulations from CMS, Department of Health Care Services (DHCS) and/or Department of Managed Health Care (DMHC).
Your Knowledge & Abilities to Bring to this Role
Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Your Physical Requirements (With or Without Accommodations)
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment 10 to 25 pounds
Ways We Are Here For You
You’ll enjoy competitive compensation for this role.
Our current hiring range is: Pay Grade: 311 - $77,863 - $124,581 ($37.43 - $59.8947).
The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
This position is approved for Full Telework (If the position is Telework, it is eligible in California only).
CalPERS pension program and additional retirement packages.
Additional benefits and perks include:
A generous PTO program
A quality work life balance
Various wellness programs
Tuition Reimbursement
Professional development opportunities
Career development opportunities
Flexible scheduling
And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.
Our Work Environment
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
If located at the 500, 505 Building or a remote work location:
No harmful environmental conditions present for this job.
The noise level in this work environment is usually moderate.
If located at PACE:
Work is typically indoors in a clinical setting serving the frail and elderly.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
If located in the Community:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
Employee will occasionally work outdoors in varied temperatures.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.
Why Join Us?
We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.
CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.
#J-18808-Ljbffr