• Job Description

  Req#: 1031
  About Avalon Healthcare Solutions:
  
  Avalon Healthcare Solutions is the world's first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans nationwide, the company covers over 44+ million lives and delivers 10-20% proven outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Program that captures, digitizes, and analyzes lab results in real-time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols and driving down overall costs.
  
  Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies. Avalon is a high growth company where every associate has an opportunity to make a difference.
  
  Avalon has years of expertise in managing lab benefits and now is leveraging digitized lab results to drive quality clinical outcomes and proven savings. When you look at how we bring this to life, we offer Lab Insights solutions that work together to arm you with critical lab-driven insights to accelerate your value-driven care success. This is the first-of-its-kind suite of solutions to help you achieve the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing the per-member cost of healthcare.
  
  You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.
  
  For more information about Avalon, please visit www.avalonhcs.com.
  
  About the Clinical Business Analyst:
  
  The Clinical Business Analyst serves as a key liaison between clinical operations, business stakeholders, and technical teams to optimize lab benefit management strategies. This role combines clinical knowledge with analytical expertise to assess, interpret, and translate business and healthcare data into actionable insights that support evidence-based decision-making, improve utilization management, and enhance operational efficiency. The Clinical Business Analyst will be responsible for gathering and documenting business requirements, identifying trends in lab test utilization, developing reports and dashboards, and supporting the implementation of clinical and policy initiatives. This position requires strong analytical thinking, healthcare domain expertise-particularly in laboratory testing-and the ability to communicate complex information effectively across multidisciplinary teams. Candidate must be proficient in written and verbal communication, proficient in SQL, knowledgeable of database structures, SDLC, reporting tools and JIRA/JQL.
  
  This position is eligible for remote work, but quarterly travel will be required to Avalon's corporate office located in Tampa, Florida.
  
  Clinical Business Analyst - Essential Functions and Responsibilities:
  
  • Analyze laboratory testing data to identify patterns, trends, and opportunities for cost and quality improvements.
  • Evaluate test utilization against evidence-based guidelines to support medical policy development and clinical decision-making.
  • Collaborate with clinical, business, and IT stakeholders to gather and define business and technical requirements for new initiatives, tools, and systems.
  • Translate clinical and business needs into clear functional specifications and process flows.
  • Develop, maintain, and enhance dashboards and reports that provide actionable insights into lab test utilization, provider behavior, and program outcomes.
  • Deliver findings and recommendations through presentations and written reports for internal teams and external clients.
  • Assist in the development, implementation, and maintenance of lab benefit management policies and clinical guidelines.
  • Support the clinical operations and medical policy teams in evaluating the impact of current and proposed policies.
  • Act as a liaison between clinical, technical, and operational teams to ensure alignment and effective communication.
  • Facilitate meetings and cross-functional workgroups to drive project outcomes and resolve issues.
  • Ensure the accuracy and integrity of clinical and business data used in reports and decision-making.
  • Conduct data validation and root cause analysis for discrepancies or anomalies in lab-related data.
  • Ensure adherence to regulatory and compliance requirements, including HIPAA and other healthcare standards.
  • Stay current with emerging trends in laboratory medicine, health informatics, and clinical analytics.
  • Identify and recommend improvements in processes, systems, and tools to enhance the efficiency and effectiveness of lab benefit management programs.
  
  Clinical Business Analyst - Minimum Qualifications:
  
  • Must be a licensed RN or LPN
  • Bachelor's degree in Nursing, Medical Management or Medical Technology, Clinical Lab Science, or Public Health
  • 7 - 10 years as a technical business or operations analyst working in a health plan IT or operational environment.
  • Experience supporting a Medical Management system and/or a Provider Portal for authorizations
  • UM background with a strong understanding of the Prior Authorization process
  • Understanding of Government programs - Medicare and Medicaid - and the regulations around them
  • Understanding of types of Commercial Member coverage - Group, Individual, Federal, ASO/Fully insured, HMO/PPO
  • Experience facilitating customer/client meetings to gather requirements - internal and external business
  • Experience documenting business requirements and reviewing them with the developers to build out the desired system functionality
  • Testing experience
  
  Clinical Business Analyst - Preferred Qualifications:
  
  • Experience with Agile teams and processes
  • Specialty benefits management knowledge or experience.
  • A minimum of 7 years' experience in information systems development, maintenance, implementation and support, preferably healthcare / managed care environments.
  • Master's or advanced degree preferred.
  • Experience using the following technology stack (SQL Server Enterprise, AWS, Containerization, Java, Spring Boot, Spring Data, Spring Batch, ReactJS, NodeJS, TypeScript, Postman, Visio/Draw.io) is desirable.
  • Knowledge or experience with clinical data is a plus (HL7, Lab, EMR).
  • Knowledge of or certification in SAFe.
  • Production support for User questions and researching issues.
  
  
  PM18

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