Utilize project management techniques to coordinate focused medical review projects as assigned. Conduct analysis to understand utilization trends.
Document and present relative data and recommendations to management and / or oversight committees. Collaborate to implement strategies to improve quality outcomes and control healthcare cost trend in alignment with corporate initiatives.
Collaborate with reporting SMEs to create reports or dashboards to reflect impact of UM programs as demonstrated by direct cost savings and / or changes in provider behavior.
Create and maintain requirements documents for each report or dashboard.
Identify, research, and resolve issues by making sound decisions in accordance with policies and procedures. Respond to telephone and written inquiries from providers and internal customers.
Act as a liaison between Medical Management and internal departments. Build professional relations with various stakeholders
- Create and maintain policy, procedure, and desktop instruction documentation. Assist with education and training to HMSA staff and providers regarding Medical Management activities / projects and seek input and cooperation for the development of new programs.
- Support and participate in department and corporate workgroups and projects, as assigned.
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
LI-Hybrid
Utilization Management Business Analyst
Utilize project management techniques to coordinate focused medical review projects as assigned. Conduct analysis to understand utilization trends. Document and present relative data and recommendations to management and/or oversight committees. Act as a liaison between Medical Management and intern...
Business Analyst III
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