Analyst III - Business Support Clinical

The work of Analysts is guided by precedents, well-defined policy and supervisory review. Incumbents determine their own priorities and may deviate from established procedures and practices as long as the end results meet standards of acceptability.

Job duties include but are not limited to:
• Research, analyze, maintain, modify, validate and prepare data, information and content used in making business decisions. Output is used for forecasting, costing, planning, positioning, trending, measuring, controlling risk, contracting and administration. Present findings and articulate results
• Monitor, maintain and test the Company’s systems that manage business and work processes
• Monitor and evaluate the effectiveness of solutions, policies, practices and processes to ensure continuous improvement, good client relations, compliance and adherence to business and system requirements. Recommend improvements to achieve and deliver high quality, value-added services
• Produce, edit and distribute a variety of business documents such as reports, system and process documentation, etc.
• Create, present and/or facilitate meetings, webinars, conference calls, training programs, education sessions, certifications, etc. for primarily internal audiences
• Participate on or lead smaller departmental projects or components of projects. May plan, organize, monitor and control projects to ensure the effective use of resources and adherence to project management standards and reporting requirements
• Participate on and/or lead department/divisional workgroups and initiatives
• Develop and build internal partnerships to improve communication, coordination, collaboration and effective working relationships within own department

Job Requirements:
• 3+ years related work experience
• Related Bachelor’s degree or additional related equivalent work experience

Preferred:
• Demonstrates understanding of healthcare regulations (e.g. CMS, NCQA)
• Knowledge of utilization management processes, prior authorization workflows, and regulatory reporting standards
• CMS-0057F Prior Auth Metrics
• NCQA Reporting & Preparation
• Familiarity with quality metrics and value-based care initiatives
• Experience with Clinical systems (e.g., UM Prior Authorizations, Grievance & Appeals, Care Management, EMR) - MCG, MC400, and MHK
• Experience with data analytics tools and visualization software
• Ability to learn and adapt to new healthcare technologies and software applications
• Serves as a clinical data resource expert and trusted advisor to UM leadership and stakeholders
• Educates interdisciplinary teams on clinical data reporting, information extraction, and system workflows
• Translates clinical needs into technical solutions
• Healthcare domain expertise and understanding of clinical work and processes
• Ability to combine clinical knowledge and analytical skills to bridge communication between technical teams and clinical stakeholders

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

This position offers a hybrid work arrangement which combines flexibility with in-office engagement. Team schedules are determined based on role requirements and business needs. Travel to and from our corporate or regional offices may be required.

What We Offer:
As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $59,800 - $97,100

Typical Annualized Hiring Range: $59,800 - $74,700

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.