Manhattan WMOS Engineer
ShyftLabs
Support Manhattan WMOS implementations and operations as a WMS Engineer at ShyftLabs. ShyftLabs builds data products and digital solutions for Fortune 500 companies.
Open
BlueCross BlueShield of Tennessee is a Tennessee-based health plan provider serving 3.4 million members through its work in healthcare and insurance. As an independent licensee of the Blue Cross Blue Shield Association and a qualified Health Insurance Marketplace issuer, the company combines health coverage with customer service and community-focused care. Its careers span a range of professional opportunities, including the BlueBridge internship program, which helps students and recent graduates begin their careers. BlueCross BlueShield of Tennessee also emphasizes a workplace where employees are valued, respected, and included.
Senior Clinical Business Analyst - Tennessee Remote
Senior Clinical Business Analyst supporting BlueCross BlueShield of Tennessee’s medical policy operations. The role combines healthcare analytics, process improvement, interoperability, and responsible AI adoption.
Description
- Advance medical policy operations with the Medical Policy Research & Development team through evidence-based practices, process improvement, and AI-enabled solutions.
- Develop and maintain medical policies through literature surveillance, regulatory and clinical guideline monitoring, and support for interoperability and healthcare digitization initiatives.
- Evaluate clinical, operational, and financial data to identify improvements in quality, utilization, access, and service delivery.
- Lead workflow and process analysis and recommend and implement evidence-based improvements.
- Convert clinical and business needs into requirements and actionable insights with clinical, operations, IT, and analytics partners.
- Provide subject-matter guidance and education on clinical workflows, data interpretation, reporting, and system functionality.
- Maintain compliance with regulatory, accreditation, and internal governance standards.
- Support the evaluation, implementation, and optimization of clinical and business processes, applications, and technology-enabled solutions.
- Evaluate, plan, and support responsible AI adoption, including use-case assessment, requirements definition, and performance monitoring.
- Analyze adoption, performance, and outcome data for technology solutions.
- Help develop policies, controls, and governance frameworks for technology use in clinical and operational settings.
Requirements
- Bachelor’s degree or equivalent professional experience is required.
- Equivalent experience means four years of professional work in healthcare, clinical operations, or a corporate environment.
- Active Tennessee or compact-state RN license, or an active Tennessee master’s-level social work license such as LMSW or LCSW.
- Three years of experience in clinical operations, care management, utilization management, population health, or a comparable healthcare setting.
- Two years of experience in reporting, data analysis, business analysis, or performance improvement.
- One year of experience supporting projects, initiatives, or cross-functional workgroups.
- Experience partnering with clinical, operational, and technical teams to improve workflows, systems, or performance outcomes.
- Experience evaluating and supporting AI-enabled or advanced analytics solutions.
- Strong analytical, critical-thinking, and problem-solving skills.
- Ability to turn clinical and operational needs into clear business requirements.
- Sound judgment regarding risk, bias, appropriateness, and governance for analytics and AI-driven clinical tools.
- Proficiency with Microsoft Office, including Outlook, Word, Excel, Access, and PowerPoint.
- Experience with database reporting and data analysis.
- Ability to work independently and collaboratively within a team.
- Demonstrated ability to manage multiple projects, priorities, and timelines.
- Excellent written and verbal communication skills.
- Strong interpersonal, organizational, and time-management abilities.
- Comfort working in a fast-moving environment with emerging technologies and shifting priorities.
- Demonstrated proficiency and comfort using AI-enabled technologies and tools.
Benefits
- Remote work arrangement.
- Employee position.
- Equal employment opportunity and nondiscrimination protections.
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