Job Description

Title: Sr. Clinical Business Analyst

We are seeking an experienced Clinical Business Analyst to support critical interoperability mandates, including CMS-0057 F. This is an urgent requirement for a highly skilled professional with strong clinical and stakeholder management experience.

Key Responsibilities:

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  Lead stakeholder meetings to gather and define requirements
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  Drive end-to-end requirements lifecycle & traceability
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  Document, validate, and map business requirements
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  Collaborate with business, IT, and QA teams
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  Support interoperability APIs (Prior Authorization focus)

Must Have Skills:

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  8+ years as BA (5+ years in Clinical environment)
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  Strong experience with CMS-0057 F mandate
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  Utilization Management (UM) & Clinical Operations expertise
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  Experience with GuidingCare (preferred), InterQual or MCG
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  Interoperability & API knowledge
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  Strong documentation, communication & stakeholder management
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  Jira experience is a plus