What are the responsibilities and job description for the Clinical BSA position at VeeRteq Solutions LLC?
Role: Senior Clinical BSA
Location: Remote USA
Seeking a Senior Clinical BSA with 10 years of healthcare payer experience, focused on Population Health, Utilization Management (UM), and Care/Case Management (CM). This role acts as a clinical functional SME, supporting Medicaid and Medicare initiatives to improve care delivery, outcomes, and compliance.
Duties: Population Health, UM & Care Management
Location: Remote USA
Seeking a Senior Clinical BSA with 10 years of healthcare payer experience, focused on Population Health, Utilization Management (UM), and Care/Case Management (CM). This role acts as a clinical functional SME, supporting Medicaid and Medicare initiatives to improve care delivery, outcomes, and compliance.
Duties: Population Health, UM & Care Management
- Clinical SME for systems supporting Pop Health, UM, and CM
- Analyze and document end to end clinical workflows, including:
- Care plans
- Prior authorizations & utilization review
- Clinical assessments
- Care coordination & transitions of care
- Convert clinical and business needs into:
- Functional requirements
- User stories
- Acceptance criteria
- Support initiatives around:
- Risk stratification
- Care gap identification/closure
- Member outreach
- Outcomes and quality tracking
- Perform gap analysis, impact analysis, and process modeling
- Create and maintain:
- BRDs / FRDs
- Workflow diagrams
- Data mappings & traceability matrices
- Partner with clinical ops, medical management, and compliance teams
- Ensure solutions align with evidence based care models and regulations
- Use SQL to validate:
- Care management data
- Authorization decisions
- Clinical outcomes & quality measures
- Utilization metrics
- Work with data/reporting teams to ensure clinical data accuracy
- Act as a bridge between:
- Clinical teams (nurses, care managers, medical directors)
- Business stakeholders
- IT, data, and integration teams
- Lead cross functional sessions
- Present complex concepts to non technical stakeholders
- Manage backlog and priorities in Agile/Scrum
- Define and support UAT
- Validate clinical workflows and authorization logic
- Support defect triage with QA teams
- Ensure compliance with:
- HIPAA
- CMS guidelines
- State Medicaid regulations
- Support audits and PHI/PII security reviews
- Bachelor's or Master's degree (IS, CS, Business, or related)
- 10 years as a Clinical / Healthcare BSA (payer environment)
- Strong expertise in:
- Population Health
- Utilization Management
- Care / Case Management
- Deep knowledge of Medicaid & Medicare workflows
- Strong documentation skills (BRDs, FRDs, user stories, STTMs, process maps)
- SQL proficiency for clinical and utilization data validation
- Experience with clinical and care management platforms
- Strong communication and stakeholder management skills
- Agile/Scrum experience