Looking to fill in 2 healthcare business analyst contract roles in Eagan MN with Utilization Management and Prior Authorization workflows  for hybrid contract role in Eagan Minnesota 55121

Hybrid -onsite 2 days per week, with Wednesdays as team anchor day, and additional day per week of choice. 
(Buildings are closed on Fridays)

If interestedd apply with word document resume , work authorization ,current location and availability for onsite work.

1)

Responsible for the analysis, development, support, reporting and coordination of business workflow automation and to implement efficient business processes at an enterprise level.

This role supports compliance requirements related to the language and content used in member communications, and ensures that updates to outbound letters and email templates are developed, reviewed, approved, and tested on a regular basis, including translations into other languages as needed.   This work is essential to maintaining accuracy, consistency, and regulatory alignment across all member-facing materials. 

Additionally, this role contributes to ongoing modernization efforts by supporting the development of a digital solutions that will enable Care Management teams to send standardized, preapproved communications to members.  This functionality will help strengthen outreach efforts and directly supports organizational goals to improve member experience and health outcomes through more consistent, technology-enaled engagement. 

Your Responsibilities

• Conducts in-depth research and analysis.
• Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.
• Documents metrics and process changes.
• Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.
• Participate in and coordinate individual projects and related activities to ensure project progresses on schedule.
• Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.
• Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.
• Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.
• Serves as senior subject matter expert associated with content, processes, and procedures.

• Approval Process
  • Complete approval for approximately 20 pending letters.
  • Collaborate with stakeholders for final sign-off.
    
    
• TDX Ticket Management
  • Submit tickets to:
    • Add/update letters in EHR systems
      
      
• System Integration & Testing
  • Validate updates in Helios, Predictal, and PowerApp.
  • Perform testing to ensure functionality post-update.
    
    
• Quality Assurance
  • Verify letter accuracy across all systems.
  • Review and update language blocks in CM letters and emails.
    
    
• Translation Oversight
  • Manage translation requests for required languages.
  • Track translated language blocks and ensure updates are implemented.
  • Validate translated content for compliance.
    
    
• Documentation & Tracking
  • Maintain CM letter log with approval dates and MID numbers.
  • Update tracking for language blocks and translations.
    
    
• Future State Development
  • Build a letter database with:
    • Language block linkage and translation tracking.
    • Metadata: dates, letter name, orientation, system access, LOB, enclosures, letterhead, return envelope, recipient type, MID/Form numbers, DHS approval date.

Required Skills and Experience

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Advanced collaborative, interpersonal, oral and written communication skills and demonstrated ability to develop accurate and appropriate communications, and advanced ability to communicate to all levels of management.
• Advanced research, analytical and problem solving skills.
• Advanced skills in Microsoft Excel, Word, and Access.
• Strong ability to make decisions based on analysis and business needs.
• Advanced ability to bring a different perspective to situations and challenge the status quo.
• Project management skills.
• Proven ability to work independently with guidance in only the most complex situations.
• High school diploma (or equivalency) and legal authorization to work in the U.S
• Project Coordination - Manage mutiple systems and stakeholders
• Technical Proficiencty -Helios, Predictal, PowerApp, and TDX Ticketing
• Attention to Detail - Ensure accuracy accross letters and systems
• Testing & QA - Validate updates and functionality
• Documentation Management - Maintain logs and metadata for compliance
• Translation Management - Oversee language requests and ensure accurate implementation
• Bachelor''s degree.

2)Seeking a Sr Clinical Business analyst for hybrid contract opportunity with my direct client in Eagan MN  with Technical Proficiency in MCG (formerly Milliman Care Guidelines), Utilization Management and Prior Authorization workflows  experience.

If interested , share your word document resume, work authorization, expected w2  hourly pay rate, current location, availability for hybrid work , skill stack and LinkedIn.

Job title: Business Analyst

Job ID: 254

JOB SUMMARY

Clinical Business Analyst

The Clinical Business Analyst is responsible for leading the design, documentation, configuration, testing, training, and ongoing support of prior authorization (PA) automation solutions using MCG clinical decision support tools and Utilization Management (UM) platforms. This role serves as a key liaison between clinical, operational, and technical stakeholders to ensure automated PA workflows align with evidence-based guidelines, regulatory requirements, and business objectives.

The ideal candidate brings deep expertise in clinical utilization management, payer operations, and healthcare IT systems, with a proven ability to translate complex clinical and regulatory requirements into scalable, automated solutions.

Key Responsibilities

Prior Authorization & UM Automation

• Lead end-to-end analysis and implementation of prior authorization automation across MCG tools and UM platforms
• Design and document automated PA workflows, decision logic, and exception handling aligned with clinical guidelines and payer policies
• Configure MCG guidelines, rules, and integrations to support automated and semi-automated authorization decisions
• Partner with UM operations to optimize workflows, reduce manual review, and improve turnaround times

Business Analysis & Solution Design

• Elicit, analyze, and document business, clinical, and functional requirements
• Translate requirements into detailed functional specifications, user stories, and process flows
• Ensure traceability between business requirements, system configuration, and testing outcomes
• Support solution design decisions with data, operational insights, and clinical best practices

Testing & Quality Assurance

• Develop and execute test strategies, test cases, and validation plans for PA automation
• Coordinate and support unit, integration, UAT, and regression testing
• Validate clinical accuracy, compliance, and operational readiness prior to production release

Training, Deployment & Support

• Create training materials and deliver training for UM nurses, providers, and operational staff
• Support go-live activities and provide post-implementation stabilization and optimization
• Act as a subject matter expert (SME) for PA automation issues, enhancements, and defect resolution

Stakeholder Collaboration & Governance

• Collaborate with clinical leadership, UM operations, IT, vendors, and compliance teams
• Ensure solutions comply with CMS, NCQA, state regulations, and payer policies
• Support audit readiness and documentation related to prior authorization decisions

Required Qualifications

• Bachelor’s degree in Healthcare, Nursing, Health Informatics, Business, or a related field (or equivalent experience)
• 5+ years of experience as a Business Analyst in healthcare, payer operations, or health IT
• Strong hands-on experience with MCG (formerly Milliman Care Guidelines)
• Proven experience with Utilization Management and Prior Authorization workflows
• Demonstrated experience designing or supporting clinical decision support or automation solutions
• Strong documentation skills, including requirements, workflows, and test artifacts

• Experience working in Agile, hybrid, or waterfall delivery environments
  Clinical background (e.g., RN, LPN, MD, PharmD) or significant clinical workflow experience
• Experience with UM platforms (e.g., Predictal, Helios, GuidingCare, TruCare, Epic UM, or similar)
• Experience integrating PA systems with EDI, APIs, or provider portals
• Experience with Jira

Core Competencies

• Clinical and operational understanding of utilization management
• Expertise in prior authorization policy interpretation and automation
• Strong analytical and problem-solving skills
• Excellent written and verbal communication
• Ability to influence without authority and manage complex stakeholder relationships
• Detail-oriented with a focus on quality, compliance, and patient impact

Working Conditions

• Hybrid, local to Twin Cities, ability to work onsite 2 days per week 
• May require participation in go-live or production support outside normal business hours