Analyst, UM

Job Description: • The Analyst, Utilization Management role is to be the subject matter expert for configuration in the prior authorization (PA) system(s) • Aiding in the creation and revision of PA documents • System configuration set-up, maintenance, support, and troubleshooting PA tools (including test, demo, and production environments) • Maintenance of the PA criteria and/or PA notification workflow rules engine including creation of system overrides • Creation and execution of notifications to external entities • Management of automatic role assignment • Accurate and efficient interdepartmental communication • Management of drug lists required for execution of approvals • Ensure the enhancement meets the business need and can be administered in an efficient fashion • Implement new client prior authorization benefit designs • Ensure clinical workflows are built and notification letters meet regulatory requirements • Audit prior authorization setup to ensure it aligns with the client’s expectations, and/or government regulations • Develop and maintain knowledge of Medicare D, Medicaid, and/or Exchange programs. • Adhere to governmental regulations (i.e., HIPAA, CMS, etc.) and processes while executing tasks, when applicable. Requirements: • One of the following required: College degree in a science or business-related field, CPhT, or at least 2 years’ experience in a related field (PBM, Health Insurance, and/or Prior Authorization) • Experience and expertise in working across multiple departments, technical and business acumen, and a “track record” of tangible success • Prior experience with Prior Authorization, or within a PBM preferred • Intermediate to expert knowledge of the Microsoft Office Suite • Experience documenting and maintaining configuration and process information • Requires detailed documentation of application changes • Hands-on troubleshooting experience with a complex multi-user business application • Knowledge of workflow management systems including role and document management • Knowledge of prior authorization processes in a health care environment preferred • Experience implementing processes to meet regulatory compliance requirements • Knowledge of Medicare D regulatory requirements required prior to or soon after hire • Participate in, adhere to, and support compliance program objectives • The ability to consistently interact cooperatively and respectfully with other employees. Benefits: • Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750! Apply Now Apply Now