Remote AI-Driven Clinical Policy Analyst

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); À distance; USD 90 000 - 120 000; Plein temps

Résumé du poste

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Sr. Clinical Business Analyst to support the Medical Policy Research & Development team with evidence-based practices, process improvement, and AI-enabled solutions.

You will analyze clinical, operational, and financial data to identify opportunities to improve quality, utilization, access, and service delivery; lead workflow analyses; and translate needs into executable requirements with cross-functional partners.

Qualifications

• 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.

Responsabilités

• 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 to enhance efficiency and outcomes.
• Translate clinical and business needs into clear requirements and actionable insights in partnership 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 related to clinical operations and data use.
• Support the 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, identifying risks and opportunities for optimization.
• Contribute to policies, controls, and governance frameworks for the use of technology in clinical and operational environments.

Connaissances

Analytical thinking

Clinical operations

Healthcare analytics

AI-enabled tools

Regulatory compliance

Communication skills

Formation

Bachelor’s Degree or equivalent experience

Outils

Microsoft Office

Excel

Policy management tools

Description du poste

BCBST BlueCross BlueShield of Tennessee, Inc. is seeking a Sr. Clinical Business Analyst to support the Medical Policy Research & Development team with evidence-based practices, process improvement, and AI-enabled solutions.

You will analyze clinical, operational, and financial data to identify opportunities to improve quality, utilization, access, and service delivery; lead workflow analyses; and translate needs into executable requirements with cross-functional partners.