Clinical Business Analyst | Prior Authorization & UM Automation
Remote • Posted 6 days ago • Updated 3 days ago
Dahl Consulting
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Summary
Location: Eagan, MN | Hybrid – onsite 2 days per week
Job Type: Contract (12 months)
Compensation: $50 - $65 per hour W2
Industry: Health Insurance
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About the Role
We are seeking a Clinical Business Analyst to support a leading organization in the health insurance and healthcare services industry. In this role, you will help design, configure, test, and support automated prior authorization solutions using clinical decision support tools and utilization management platforms. You will collaborate closely with clinical, operational, and technical teams to ensure automated workflows align with evidence-based guidelines, regulatory requirements, and business needs.
The Clinical Business Analyst leads the end-to-end design and implementation of prior authorization automation, leveraging MCG clinical guidelines and utilization management technologies. This role gathers and documents business and clinical requirements, creates functional specifications, supports solution design, and drives testing and quality assurance activities. Responsibilities include developing automated workflows, ensuring clinical accuracy and compliance, delivering training, supporting go-live activities, and serving as a subject matter expert for prior authorization automation. You will work cross-functionally with clinical leadership, operations, IT, vendors, and compliance teams to ensure solutions support regulatory standards and organizational goals.
Required
- Bachelor’s degree in Healthcare, Nursing, Health Informatics, Business, or a related field (or equivalent experience)
- 5 or more years of experience as a Business Analyst in healthcare, payer operations, or health IT
- Strong hands-on experience with MCG (formerly Milliman Care Guidelines)
- Experience with utilization management and prior authorization workflows
- Demonstrated experience designing or supporting clinical decision support or automation solutions
- Strong documentation skills for requirements, workflows, and testing artifacts
- Experience working in Agile, hybrid, or waterfall delivery environments
- Clinical background such as RN, LPN, MD, or PharmD, or extensive clinical workflow experience
- Experience with UM platforms such as Predictal, Helios, GuidingCare, TruCare, or Epic UM
- Experience integrating prior authorization systems with EDI, APIs, or provider portals
- Experience using Jira
Dahl Consulting is proud to offer a comprehensive benefits package to eligible employees that will allow you to choose the best coverage to meet your family’s needs. For details, please review the DAHL Benefits Summary: https://www.dahlconsulting.com/benefits-w2fta/.
Take the first step on your new career path! To submit yourself for consideration for this role, simply click the apply button and complete our mobile-friendly online application. Once we’ve reviewed your application details, a recruiter will reach out to you with next steps!
As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!
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- Dice Id: 10109792
- Position Id: 29016
- Posted 6 days ago
Company Info
Since 1993, Dahl Consulting has been a leader in providing and implementing adaptive staffing and workforce solutions for its clients. DAHL specializes in workforce process management, vendor management services, as well as sourcing and staffing services. Their workforce solutions and programs ensure clients have the right people, the right process, and the right relationships, all at the right cost. DAHL s size and service offerings enable them the flexibility to provide simple and affordable solutions adaptable to any enterprise s current program, as well as future growth. Visit www.dahlconsulting.com for more information.
The mission of Dahl Consulting is to assist businesses with the creation, delivery, and support of new and existing systems to improve their level of performance through one or a combination of our service offerings. Our core competency is managing the process of procuring contract and temporary labor by finding creative ways to maximize the efficiency and effectiveness of the customer's contingent labor program.
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