Business Analyst

TEKsystems
$40.00 - $60.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, Maryland, Hanover
7437 Race Road (Show on map)
Feb 21, 2025
Description The Clinical Decision Configuration Analyst is responsible for configuration of clinical pharmacy prior authorization (PA) criteria, business rules, program assignments and correspondence in the decision management and contact management applications for all lines of business. Responsibilities * Configure appropriate tables and settings in the decision management and contact management applications; complete content build and revisions related to criteria and fax form intake requests to ensure review tools are available when expected * Identify areas for improvement to prevent quality issues from recurring * Analyze requests, develop and validate plans including assessment of relevant formulary data and/or Utilization Management (UM) policy for automation opportunity and potential impacts on tool performance and maintenance requirements * Execute peer reviews or other quality measures to ensure all clinical review criteria and/or correspondence tools meet high quality standards and prevent quality issues from reoccurring; partner with internal teams (i.e., Testing, Training, Contact Center, Account Management) to research any discrepancies identified * Provide support and educate internal partners (i.e., Clinical Call Center, Utilization Management, Service Delivery etc.) on appropriate use of the tools * Other duties as assigned Skills Business analysis, Requirements gathering, Business requirements, Requirement gathering, Business process, Data analysis Top Skills Details Business analysis, Requirements gathering, Business requirements Additional Skills & Qualifications Education & Experience * Bachelor's degree in business or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required * 2 years of work experience in the PBM or healthcare industry Must be eligible to work in the United States without the need for work visa or residency sponsorship. Additional Qualifications * Demonstrated proficiency in basic office productivity software and tools (MS Word, Excel, One Note, One Drive, Outlook, Teams, etc.) * Strong Organizational, analytical, and interpretive skills * Strong verbal and written communication skills * Ability to self-motivate and work with minimal supervision with a high level of accountability * Strong problem-solving skills that include research and utilizing resources * Ability to work under strict timelines while managing multiple priorities simultaneously Preferred Qualifications * 2 years work experience in clinical or benefit configuration role * National Pharmacy Technician Certification through PTCB or ExCPT (CPhT) * Experience using relevant clinical program applications (e.g., SinglePoint, Unity, MRx Decide, First Trax configuration) * Experience in review process and/or benefit design for multiple clients Experience Level Intermediate Level Pay and Benefits The pay range for this position is $40.00 - $60.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Feb 26, 2025. About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.