Clinical Regulatory Oversight, Business Analyst III

Clinical Regulatory Oversight, Business Analyst III

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Clinical Regulatory Oversight Business Analysts provides analytical documentation, and reporting support from prior authorization submission through claims payment to the Clinical Regulatory Oversight team. This role supports regulatory compliance activities impacting Clinical Services including Utilization Management (UM), Appeals, and Grievances (AG) and Care Management (CM) by assisting with audit readiness, NCQA deliverables, reporting requirements, and maintenance of regulatory documentation. The Business Analyst partners closely with Program Managers and cross-functional stakeholders to ensure regulatory requirements are accurately implemented, monitored, and supported by defensible data and documentation. Performs other duties as assigned.

Key Accountabilities

• Regulatory and Audit Support
  • Support internal, state, federal, and accreditation audits by gathering, organizing, and validating regulatory documentation and data.
  • Maintain audit trackers, issue logs, evidence inventories, and corrective action tracking tools.
  • Assist Program Managers with preparation of audit responses and follow-up materials.
• Reporting and Data Validation
  • Assist with gathering State and Federal regulatory, NCQA, and internal reporting requirements that impact UM, AG and CM or operating models.
  • Validate accuracy, completeness, and consistency of data across reports and source systems.
  • Partner with analytics, operations, and vendors to resolve data discrepancies.
• Regulatory Implementation Support
  • Support implementation of new or updated State and Federal regulatory requirements by documenting workflows, requirements, and controls.
  • Track implementation milestones and deliverables.
  • Identify opportunities to improve regulatory tracking, reporting, and documentation processes.
• Policies, Procedures, and Documentation
  • Maintain regulatory documentation inventories, crosswalks, and version control logs.
  • Support updates to policies, procedures, job aids, and letter templates under direction of Program Managers.
  • Ensure documents align with regulatory, accreditation, and internal standards.
• Cross-Functional Collaboration
  • Collaborate with Program Managers, compliance, operations, quality, and analytics teams.
  • Prepare summaries, trackers, and presentation materials for leadership and governance forums.

Required Qualifications

• Bachelor's degree or equivalent experience in related field.
• 5+ years of business analysis, regulatory support, compliance, quality, or healthcare operations experience beyond degree.

Preferred Qualifications

• Strong analytical, documentation, and organizational skills.
• Advanced proficiency in Microsoft Excel and Microsoft Office.
• Excellent written and verbal communication skills.
• Project Management skills.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE.

The full salary grade for this position is $78,700 - $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 - $118,020. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.