Clinical Services Optimization Business Analyst III

Medica•Minnetonka, MN

3d•Hybrid

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. This analyst will work within Medica’s Clinical Services Optimization division, specifically focused on electronic prior authorization business delivery. The analyst role is responsible to gather, research, document requirements, and maintain daily operations of ePA. This role collaborates with partners from cross-functional business areas, like network, Tech, and claims operations. They will manage the process from requirements gathering through delivery, including maintenance and validation. They will operationalize regulatory and/or business requirements, including process improvement and work related to growth initiatives. This role acts as our ePA clinical documentation system expert and liaises between Clinical Services and other business domains, Medica IT, clinical platform vendor, and reporting teams. Performs other duties as assigned.

Requirements

Bachelor’s degree or equivalent combination of education and related work experience
5+ years of related experience with 4+ years of experience working on large organizational projects
Skills and Abilities Implementation and new capabilities delivery experience
Computer proficiencies including Microsoft Office (Word, Excel, Access, Outlook, Visio, Onenote, Teams, etc.) and experience with other Program functions (workflow, eligibility, claims, etc.)
Ability to lead and be a good role model, influence change, shape and initiate work with colleagues across the organization and external (care systems, community collaborations, and vendors) to achieve department goals
Ability to provide leadership based on teamwork, commitment & creative linkages with organizational business units, external vendors and care system representatives
Excellent written and verbal communication skills with all levels of the organization
Knowledge of computer applications, such as Microsoft Office, Microsoft Project and Vision, Access, and familiarity with using database systems
Managing/Delegating/Measuring Work: Ability to develop and assign clear, appropriate objectives, accountabilities and measures working within cross functional workstreams. Ability to monitor and report progress; identify and address barriers
Quality Focus: Commitment to continuous quality improvement in all aspects of work. Skilled user of quality tools and techniques
Experience setting expectation and direction for program delivery
Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.
This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

Responsibilities

Analyst for ePA delivery
Support daily delivery of ePA workflow Including but not limited to: process efficiency, error handling, business validation & UAT
Ensures systems and processes are working as designed, evaluates system processes and procedures, evaluates requests for changes to the system, develops recommendations to solve problems and issues related to business system and reporting
Reduces manual processes and duplication by implementing automation and standardized practices
Oversight of ePA delivery process, workflow, and execution. Including: internal and external UM
Research and speak expertly regarding the functionality of our clinical documentation system; includes providing support as the system subject matter expert within business and project teams
Drives recommendations and process improvement efforts with stakeholders and facilitates decisions by listening to and collaborating with business stakeholders
Interpret customer needs, translating them into application and operational requirements
Cross functional Collaboration Work cross functional with business partner to achieve program delivery
Create strong partner relationship to be successful
Drive Clinical and Health Service business readiness by leading for success strategies