Utilization Management Program Analyst

Curative HR LLC • Austin, TX

35d

About The Position

The Utilization Management Program Analyst supports the development, implementation, and ongoing optimization of the organization’s utilization management (UM) program. This role partners with clinical leadership, pharmacy, medical policy, and operational teams to evaluate prior authorization requirements, support medical policy implementation, maintain UM program documentation, and analyze utilization trends. The position plays an important role in ensuring the effectiveness, compliance, and continuous improvement of the UM program by assessing approval and denial patterns, supporting policy updates, coordinating responses to regulatory and audit requests, and assisting with cross-functional training initiatives.

Requirements

• Demonstrated ability to manage projects, interpret data, and communicate effectively with stakeholders.
• Familiarity with medical coding systems (CPT, HCPCS, ICD-10)
• Experience supporting prior authorization programs or utilization management processes
• Experience with data analysis, reporting, or cost/utilization analysis
• Strong organizational skills and attention to detail.
• Ability to work independently and take initiative.
• Bachelor’s degree in healthcare administration, public health, health policy, business, or related field 2–5 years of experience in utilization management, healthcare operations, medical policy, or healthcare analytics
• Minimum of two years of experience in related role within a healthcare or medical management setting.

Responsibilities

• Support the ongoing development, implementation, and evaluation of the Utilization Management program
• Analyze utilization trends and identify opportunities to add, modify, or remove procedure codes from prior authorization requirements
• Monitor and evaluate approval and denial rates, utilization patterns, and cost trends
• Conduct cost and utilization analyses to assess the impact of UM policies and program changes
• Provide data-driven insights to support program improvements and operational decision-making
• Support the maintenance and periodic updates of UM policies and procedures
• Assist with updates to the Utilization Management Program Description, including annual review and revisions
• Ensure alignment between UM policies, medical policies, and prior authorization requirements
• Coordinate internal review and documentation of policy updates with relevant stakeholders
• Support implementation of facility medical policies within UM processes and workflows
• Collaborate with clinical and operational teams to ensure policies are operationalized effectively
• Assist with communication and documentation related to policy changes
• Coordinate responses to regulatory requests, audits, and external inquiries
• Maintain documentation supporting UM compliance and regulatory requirements
• Monitor regulatory updates that may impact UM policies or operational practices
• Track and maintain documentation for clinical licensure requirements related to UM activities
• Support compliance with state and regulatory requirements regarding clinical participation in UM processes
• Support development and coordination of training for pharmacy and medical teams
• Assist in creating training materials related to UM policies, workflows, and regulatory requirements
• Serve as a liaison between UM, pharmacy, clinical, compliance, and operational teams
• Assist with coordination of UM program initiatives and projects
• Track deliverables, timelines, and implementation activities
• Support reporting and documentation related to UM program performance
• Assist department leadership with day-to-day team management and administrative tasks. Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc).
• This position assumes and performs other duties as assigned.

Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)
• $0 copays and $0 deductibles (with completion of our Baseline Visit )
• Preventive and primary care built in
• Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)
• One-on-one care navigation
• Chronic condition programs (diabetes, weight, hypertension)
• Maternity and family planning support
• 24/7/365 Curative Telehealth
• Pharmacy benefits
• Comprehensive dental and vision coverage
• Employer-provided life and disability coverage with additional supplemental options
• Flexible spending accounts
• Flexible work options: remote and in-person opportunities
• Generous PTO policy plus 11 paid annual company holidays
• 401K for full-time employees
• Generous Up to 8–12 weeks paid parental leave, based on role eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 11-50 employees