The role involves designing and implementing a quality management strategy that satisfies expectations from internal and external constituents, including NCQA and state regulators for Medicaid and CHIP. Responsibilities include participating in Quality Management work plans, analyzing health plan activities, and converting data analysis results into meaningful business information for dissemination.

This role assists in prioritizing projects, auditing alignment with strategy, guiding resource allocation, and supporting portfolio execution plans, while managing Agile/Lean portfolios and supporting overall strategy and investment funding. The analyst develops and monitors reporting metrics and dashboards to ensure predictable project success and creates visibility into areas struggling with scope, schedule, resources, or budget.

The role utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program, specifically for preauthorization of mental health services. This involves applying critical thinking and knowledge of clinically appropriate treatment and evidence-based care within a call center setting.

The Senior Business Systems Analyst coordinates with vendors, partners, architects, and leadership to facilitate complex cross-departmental requirement gathering and consults on system implementations, integrations, and upgrades for all departments within PS&D.