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Senior Clinical Business Analyst
BlueCross BlueShield of Tennessee. Support the Medical Policy Research & Development team by advancing medical policy operations through evidence-based practices, process improvement, and AI-enabled solutions .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in medical policy operations, clinical workflows, and data analysis to drive evidence-based improvements in healthcare settings. Proficient in collaborating with cross-functional teams to implement AI-enabled solutions and ensure compliance with regulatory standards.
Highest-signal resume keywords
Registered Nurse (RN) LicenseClinical Operations ExperienceData Analysis and ReportingAI-Enabled Solutions EvaluationProcess Improvement
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data AnalysisClinical Workflow AnalysisEvidence-Based PracticesRegulatory CompliancePerformance ImprovementHealthcare DigitizationInteroperability SupportBusiness Requirements TranslationAI Initiative SupportDatabase Reporting
Soft Skills
Analytical ThinkingProblem-SolvingCommunication SkillsInterpersonal SkillsOrganizational Skills
Tools & Technologies
Microsoft Office SuiteAI-Enabled TechnologiesHealthcare ApplicationsData Analysis Tools
Certifications & Qualifications
Bachelor’s DegreeRegistered Nurse (RN) LicenseMaster’s-level Social Worker License (LMSW, LCSW)
Industry Keywords
HealthcareClinical OperationsUtilization ManagementPopulation HealthCare Management
About the role
Key responsibilities & impact- Support the Medical Policy Research & Development team by advancing medical policy operations through evidence-based practices, process improvement, and AI-enabled solutions
- Drive the development and maintenance of medical policies through literature surveillance, regulatory and clinical guideline monitoring, and support for interoperability and healthcare digitization initiatives
- Analyze clinical, operational, and financial data to identify opportunities to improve quality, utilization, access, and service delivery
- Lead workflow and process analysis, recommending and implementing evidence-based improvements
- Translate clinical and business needs into requirements and actionable insights with clinical, operations, IT, and analytics teams
- Provide subject-matter expertise and education on clinical workflows, data interpretation, reporting, and system functionality
- Ensure compliance with regulatory, accreditation, and internal governance standards
- Support evaluation, implementation, and optimization of clinical and business processes, applications, and technology-enabled solutions
- Assess, plan, and support responsible adoption of AI initiatives, including use case evaluation, requirements definition, and performance monitoring
- Analyze adoption, performance, and outcome data for technology solutions
- Contribute to policies, controls, and governance frameworks for technology use in clinical and operational environments
Requirements
What you’ll need- Bachelor’s Degree required, or equivalent professional experience
- Equivalent experience defined as 4 years of professional work experience in a healthcare, clinical operations, or corporate environment
- Registered Nurse (RN) with an active license in the state of Tennessee or a compact state OR Master’s-level Social Worker with an active Tennessee license (e.g., LMSW, LCSW)
- 3 years of experience in clinical operations, care management, utilization management, population health, or a comparable healthcare setting
- 2 years of experience in reporting, data analysis, business analysis, or performance improvement
- 1 year of experience supporting projects, initiatives, or cross-functional workgroups
- Demonstrated experience collaborating with clinical, operational, and technical partners to improve workflows, systems, or performance outcomes
- Experience evaluating and supporting AI-enabled or advanced analytics solutions
- Strong analytical, critical thinking, and problem-solving abilities
- Ability to translate clinical and operational needs into clear business requirements
- Strong judgment related to risk, bias, appropriateness, and governance considerations for analytics and AI-driven tools in clinical settings
- Proficient in Microsoft Office (Outlook, Word, Excel, Access, PowerPoint)
- Database reporting and data analysis experience
- Ability to work independently and collaboratively within a team environment
- Proven ability to manage multiple projects, priorities, and timelines
- Excellent oral and written communication skills
- Strong interpersonal, organizational, and time-management skills
- Comfort operating in a fast-paced, evolving environment with emerging technologies and changing priorities
- Demonstrated proficiency and comfort working with AI-enabled technologies and tools
Benefits
Comp & perks- Remote work arrangement
- Employee position
- Equal employment opportunity and nondiscrimination protections