Business Analyst III Managed Care Operations

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California 

***This position is work from home within California.

Position Summary:

The Business Analyst (BA) III will serve as the internal consultant for the Managed Care Operations team, providing analysis, reporting, and operational support across a variety of functions, including credentialing, contracting, claims, provider relations, quality/risk, care coordination, utilization management, and business development. They will bridge the gap between operational needs and technology solutions, ensuring data integrity and actionable insights for key stakeholders. As part of the BA Hub, these roles will also partner closely with the Population Health Analytics function to ensure consistent and accurate reporting across all markets.

Responsiblities may include:
- Lead the analysis and evaluation of data, processes, and systems related to Managed Care Operations, ensuring they align with strategic business goals.
- Oversee and drive improvements across multiple functional areas, including credentialing, contracting, provider relations, and care coordination.
- Serve as the lead SME for the Managed Care Operations Hub, ensuring the integration of operational needs with data governance, analytics, and reporting.
- Develop comprehensive business cases for process improvements, including cost, service, and benefit dimensions.
- Manage and coordinate complex projects, ensuring alignment across teams and providing recommendations to leadership for operational efficiency improvements.
- Conduct high-level analysis to identify emerging trends and opportunities for improvement within Managed Care Operations.
- Lead the creation and execution of advanced reporting and dashboard tools to track KPIs and drive continuous operational improvements.
- Partner with Population Health Analytics to ensure the alignment of data analytics and managed care reporting across markets.

Minimum Qualifications:

- 5+ years of experience in business analysis within managed care operations, including hands-on experience with contracting, claims management, and care coordination.
- Bachelor's degree or 5 years of equivalent work experience in any of the following environments; healthcare administration, managed care business, information technology, or related fields.
- Advanced proficiency in data analysis tools (e.g., SQL, PowerBI, Excel).
- Proven track record of leading complex projects, developing data-driven strategies, and driving operational efficiency.
- Strong experience in stakeholder management, reporting, and performance monitoring within managed care environments.
- Strong analytical and problem-solving skills, with the ability to interpret complex data sets and identify key trends.
- Ability to effectively communicate with stakeholders at all levels, translating technical findings into actionable business insights.
- Demonstrated ability to collaborate across functions to deliver operational improvements and strategic initiatives.
- Familiarity with HIPAA regulations and data governance best practices.

Preferred Qualifications:

- Masters' degree in computer science, mathematics, management information systems, or a closely related field preferred.
- Experience in leading cross-functional teams within managed care operations, with a focus on strategic project management and process optimization preferred.
- Advanced knowledge of data governance, data integration, and reporting systems within the context of managed care preferred.
- Strong familiarity with healthcare data standards (e.g., HIPAA compliance, EDI transactions, 837/834 files), and managed care systems (e.g., EZCAP, Qnxt, ImageNet) preferred.
- Proven ability to translate business needs into technical solutions, working closely with IT teams to drive system improvements and enhance optional performance preferred.