Business Analyst-Clinical

Logisolve is a seeking a clinical business analyst for a 12+ month consulting opportunity with our direct healthcare client. The Clinical Business Analystis responsible for leading the design, documentation, configuration, testing, training, and ongoing support ofprior authorization (PA) automation solutions using

MCG clinical decision support toolsand

Utilization Management (UM) platforms. This role serves as a key liaison between clinical, operational, and technical stakeholders to ensure automated PA workflows align with evidence-based guidelines, regulatory requirements, and business objectives.

The ideal candidate brings deep expertise in clinical utilization management, payer operations, and healthcare IT systems, with a proven ability to translate complex clinical and regulatory requirements into scalable, automated solutions.

Duration: 12+ months-likely extensions

Compensation: $58.06/hr w2-no 1099/CTC-must work direct to Logisolve to be considered

Logisolve offers medical, dental, vision, life insurance, short-term disability, long-term disability, paid sick leave, and retirement benefits to eligible employees.

Location: Eagan, MN-hybrid 2 days a week

• Lead end-to-end analysis and implementation ofprior authorization automation across MCG tools and UM platforms
• Design and document automated PA workflows, decision logic, and exception handling aligned with clinical guidelines and payer policies
• Configure MCG guidelines, rules, and integrations to support automated and semi-automated authorization decisions
• Partner with UM operations to optimize workflows, reduce manual review, and improve turnaround times

• Elicit, analyze, and document business, clinical, and functional requirements
• Translate requirements into detailed functional specifications, user stories, and process flows
• Ensure traceability between business requirements, system configuration, and testing outcomes
• Support solution design decisions with data, operational insights, and clinical best practices

• Develop and execute test strategies, test cases, and validation plansfor PA automation
• Coordinate and support unit, integration, UAT, and regression testing
• Validate clinical accuracy, compliance, and operational readiness prior to production release

• Create training materials and deliver training for UM nurses, providers, and operational staff
• Support go-live activities and provide post-implementation stabilization and optimization
• Act as a subject matter expert (SME) for PA automation issues, enhancements, and defect resolution

• Collaborate with clinical leadership, UM operations, IT, vendors, and compliance teams
• Ensure solutions comply with
  
  CMS, NCQA, state regulations, and payer policies
• Support audit readiness and documentation related to prior authorization decisions

• Bachelor’s degree in Healthcare, Nursing, Health Informatics, Business, or a related field(or equivalent experience)
• 5+ yearsof experience as a Business Analyst in healthcare, payer operations, or health IT
• Strong hands-on experience with MCG (formerly Milliman Care Guidelines)
• Proven experience with Utilization Management and Prior Authorization workflows
• Demonstrated experience designing or supporting clinical decision support or automation solutions
• Strong documentation skills, including requirements, workflows, and test artifacts
• Experience working in Agile, hybrid, or waterfall delivery environments

• Clinical background (e.g., RN, LPN, MD, Pharm
  
  D) or significant clinical workflow experience
• Experience with UM platforms (e.g., Predictal, Helios, Guiding Care, Tru Care, Epic UM, or similar)
• Experience integrating PA systems with
  
  EDI, APIs, or provider portals
• Experience with Jira

• Clinical and operational understanding of utilization management
• Expertise in prior authorization policy interpretation and automation
• Strong analytical and problem-solving skills
• Ability to influence without authority and manage complex stakeholder relationships
• Detail-oriented with a focus of quality, compliance, and patient impact

• Hybrid, local to Twin Cities, ability to work onsite 2 days per week
• May require participation in go-live or production support outside normal business hours

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