Business Analyst Sr, Clinical Operations

Business Analyst Sr, Clinical Operations Job no: 493955 Work type: Full Time Location: 505 City Parkway West Categories: Medical / Clinical Overview We are a mission‑driven, community‑based organization that serves member health with excellence and dignity. You will join our MM – Utilization / Case Management team as a Business Analyst Sr, Clinical Operations, leading the full lifecycle of reporting and data analysis. This position has been approved for Full Telework – if telework is approved, work must be within the State of California only; if partial telework is chosen, the employee must be in the Main Office in Orange, CA, at least two (2) days per week. Key Responsibilities Conduct business analysis for Clinical Operations, translating complex needs into actionable analytical and reporting solutions. Lead the lifecycle of reporting and data analysis: requirements gathering, testing, solution design, validation, deployment, and post‑implementation evaluation. Evaluate business processes, identify opportunities, ensure reporting accuracy, compliance, and alignment with organizational goals. Provide analytical support and expertise on requests for information from executives, directors, and other staff regarding claims, authorization and enrollment data. Act as liaison between Clinical Operations business owners and reporting teams; support cross‑functional reporting initiatives with IT and Financial Analysis. Create comprehensive business user test scenarios, schedules, and provide timely reporting of issues impacting testing progress. Conduct system research and testing to ensure reports produce expected results; maintain version control and documentation accuracy. Monitor report usage and effectiveness post‑deployment; ensure ongoing business needs are met. Maintain core competency in Clinical Operations programs, staying current on program design, requirements, and operational changes. Collaborate with Clinical Operations leadership and program teams on configuration, training, and alignment with CalOptima Health policies and procedures. Notify leadership of impacts on reporting and processes; communicate changes that affect business operations. Remain informed about state, federal and commercial health care environments and monitor resources such as CMS updates, Medi‑Cal bulletins and manuals. Facilitate communication on report‑related topics and review ad‑hoc analysis as requested. Complete additional projects and duties as assigned. Qualifications 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. Equivalent combination of education and experience sufficient to perform essential duties qualifies. Preferred Qualifications Experience with case management and/or utilization management data, clinical systems and processes. Experience meeting regulations from CMS, DHCS and/or DMHC. Knowledge & Abilities Develop rapport and maintain effective working relationships with CalOptima Health leadership, staff, and external contacts. Work independently with sound judgment. Communicate clearly and concisely, orally and in writing. Work a flexible schedule; available for evening and weekend events. Organize, be analytical, problem‑solve, and possess project‑management skills. Manage multiple projects and identify opportunities for collaboration. Motivate and lead multi‑program teams and external committees/coalitions. Utilize computer applications (Microsoft Office, Outlook, Excel, PowerPoint) and job‑specific systems to produce correspondence and analytical information. Physical Requirements Ability to visually read information from screens, forms and printed materials. Ability to speak and be heard clearly. Manual dexterity for typing, writing, standing, reaching, and flexibility. Lifting and moving objects 10–25 pounds. Benefits Competitive compensation – Pay Grade: 311 – $77,863 – $124,581 ($37.43 – $59.89) Full Telework (eligible in California only). Comprehensive benefits package, including CalPERS pension program and additional retirement packages. Generous PTO, quality work‑life balance, wellness programs, tuition reimbursement, professional development, career development opportunities, flexible scheduling. Equal Employment Opportunity Statement CalOptima Health is an equal‑opportunity employer and makes all employment decisions on the basis of merit. We prohibit unlawful discrimination based on any protected characteristic and are committed to providing reasonable accommodations for qualified applicants with disabilities. #J-18808-Ljbffr CalOptima Health