Utilization and Pre Authorization Analyst
About The Position
HealthEZ is seeking a detail-oriented and process-driven Utilization and Pre-Authorization Analyst with a proven track record of success in healthcare operations. As a key member of the Medical Management team, this role will support critical utilization review and pre-authorization functions while collaborating closely with internal and external stakeholders. Reporting to the Director of Clinical Operations, the Analyst will play an important role in ensuring efficient, accurate, and compliant healthcare service delivery. This is a hybrid position, requiring onsite presence three days per week and offering the flexibility to work remotely two days per week.
Requirements
- Bachelor's Degree in health sciences or related field with 3+ years of progressive experience in the healthcare industry or Associate's degree with 4+ years of progressive related experience.
- Experience in prior authorization, utilization management, clinical operations, health plan operations and delegated UM operations.
- Ability to translate clinical, regulatory, vendor, and operational requirements into clear business rules and documentation standards.
- Strong understanding of authorization workflows, service categories, documentation requirements, and routing logic.
- Experience maintaining inventories, rule libraries, logs, trackers, or governance documents with version control and effective dates.
- Proven ability to work effectively with IT, vendors, Medical Management, Clinical Operations and operational stakeholders to resolve gaps and drive decisions.
- Strong analytical, organizational, and communication skills with attention to detail and follow through.
Responsibilities
- Translate clinical, regulatory, vendor and operational requirements into clear authorization rules, service data.
- Establish documentation standards, testing scenarios and governance processes.
- Able to effectively work across different departments within the organization including Medical Management, Clinical Operations, IT.
- Establish and maintain vendor relationships and delegated UM partners.
- Ability to organize complex information, identify gaps, maintain version control.
- Support both implementation readiness and long-term operations sustainability.
Benefits
- health benefits
- retirement plan (401k)
- paid time off
- paid leave including parental leave
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
