Utilization Management Business Analyst II - 26-75

PriMed Management Consulting•San Ramon, CA

38d

About The Position

The Utilization Management Business Analyst will serve as a critical link between our Authorizations operations and IT teams, focusing on optimizing the utilization management workflows within the Epic system. This role will analyze business processes, design solutions, and support the implementation and maintenance of the Epic Utilization Management module to enhance operational efficiencies and ensure compliance with regulatory requirements. This role will report to Manager, Authorizations Business Product Management.

Requirements

Epic Tapestry UM/CM or other related modules certification required.
A minimum of 3 years of experience with Epic Reporting Workbench required.
A minimum of 3 years of experience as Business/Systems Analyst or similar position required.
Demonstrated ability to elicit, analyze and communicate business requirements effectively.
Ability and willingness to build positive relationships with internal and external teams.
Excellent communication, critical and analytical thinking, and problem-solving skills.
Ability to exercise good judgment and prioritize multiple tasks.
Ability to work independently, showing initiative and being pro-active.
Proficient with MS Office: Excel, Outlook, Word, Teams and PowerPoint.

Responsibilities

First tier support for Utilization Management team and integrated team workflows with, Compliance, Contracting, Concurrent review, Enrollment, Claims, Customer Services, Regional Services and Provider data teams.
Route and track complex issues, system configuration requests to IT and other teams as necessary.
Conduct analysis for issues identified.
Intake enhancement requests and recommend potential system solutions.
Gather business requirements from necessary business stakeholders.
Secure leadership approval of the requirements and system workflow/design as necessary.
Point person for all testing needs for system updates – Operational changes, enhancements, reports, and projects.
Generate and distribute reports using Epic Reporting Workbench (RWB) for UM Leadership and Compliance Audits.
Perform necessary data analysis to present summaries and recommendations relevant to the audience.
Collaborate with Informatics team for complex reports, dashboards.
Distribute announcements for system updates and participate in system demonstration, training content creation as necessary.
Coordinate to ensure operationalization of system workflow changes working with internal and external stakeholders.
Own adjudication rules monitoring, maintenance, and identify opportunities to improve auto approval rate in Tapestry, in collaboration with Business and IT Teams.
Own procedure codes and code levels maintenance, in collaboration with Business and IT Teams.
Participate in analysis and present recommendations for codes monitoring and outliers identified by Informatics team(s).
Own integrated UM workflows in Tapestry, in collaboration with Business and IT Teams.
Own WQ routing and maintenance, in collaboration with Business and IT Teams.
Participate in Epic IT projects representing the department, mitigating potential risks to Utilization Management team KPIs – Electronic adjudication (EA) rate, Turnaround time (TAT) compliance and pending work queue volumes.
Participate in Data Governance stewardship meetings and initiatives representing -Utilization Management team to identify and solve for the team’s data needs.