UTILIZATION MANAGEMENT BUSINESS ANALYST

TRAVEL REQUIREMENTS: REMOTE TO START

The Utilization Management Business Analyst will support and drive the daily activities for Business Analysis of metrics within the Utilization Management department. In this position, you would come with a clinical/care management background and experience in addition to being a licensed RN where you will work independently as part of the Clinical Operations & Quality Team providing report build, data analysis, validating metrics and reporting for medical management functions including care management, and utilization management.  Responsibilities also include creating presentations of the monthly metrics for clients, and generating monthly, quarterly, annual, ad-hoc reporting. Additionally, you will assist with the development and production of UM operational and outcome metrics, develops, and designs reports and creates and maintains databases to support the business requirements of the team.  WHAT YOU'LL DO:

• Develop and maintain reporting on client deliverables and key indicators regarding medical management functions including care management, and medical management (utilization management) to ensure contract requirements, federal and state laws and regulations, and national accreditation standards are met.
• Responsible for evaluating and documenting clinical processes, including step actions and workflows to construct and enhance the clinical model of care.
• Acts as subject matter expert for an assigned work stream unit - Intake, UM, CM, DM, Reporting or Appeals.
• Assists in the documentation and gathering of detailed requirements and workflow processes and analysis.
• Reviews current workflow and lead recommendations and defines requirements to build processes and forms needed to support the business in the new system.
• Recommends and implements software based on best practices.
• Generates new and existing UM reports on defined schedule and on an ad hoc basis.
• Models new UM metrics or changes in methodology.
• Perform various analysis and interpretation to link business needs and objectives for assigned function.
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations
• Works collaboratively with various levels of clinical staff and Information Systems staff to clarify needs, prioritize requests, and recommend workflow enhancements.
• Analyzes customer needs and identify system and procedural solutions to enhance the clinical practices.
• Identifies opportunities to leverage technologies in areas that improve and promote the clinical agenda.
• Performs gap analysis.
• Coordinate with various business units and departments in the development and delivery of training programs
• Develop, share, and incorporate organizational best practices into business applications
• Diagnose problems and identify opportunities for process redesign and improvement
• Formulate and update departmental policies and procedures
• Serve as the subject matter expert on the assigned function product to ensure operational performance.

YOU'LL BE SUCCESSFUL IF:

• You have 5+ years of nursing experience in a managed care environment. 
• You have 5+ years of utilization management and/or case management experience. 
• Bachelor's degree in Nursing or equivalent experience.
• Current & Active RN License
• 5+ years of experience in a position that requires participation in and knowledge of Care Management operations and regulations that affect clinical processes and reporting
• Minimum of 5 years related experience in healthcare administration and/or managed care environments preferred

WHAT YOU'LL BRING:

• Bachelor's degree in Nursing or equivalent experience.
• 5+ years of nursing experience in a  managed care environment.
• 5+ years of utilization management and/or case management experience.
• Preferred Demonstrated interpersonal/verbal communication skills
• Ability to effectively present information and respond to questions from peers and management
• Demonstrated organizational skills
• Ability to remain calm under pressure
• Ability to read, write and modify SQL queries.
• Detail oriented with excellent organizational skills
• Must be able to work on multiple initiatives simultaneously
• Must be able to work independently with minimal supervision
• Strong interpersonal, oral and written communication skills.

ABOUT IMPRESIV HEALTH:

Impresiv Health is a healthcare consulting and staffing partner specializing in operations management consulting and business optimization services for companies across the healthcare continuum. Started on the belief that a firm's foundation could be built with a team of thought leaders and proven industry experts, we've established a company that delivers quick and efficient results for our clients. ​

We offer strategic business and technical management consulting services, and a suite of staffing solutions. ​

Impresiv Health is a services partner with a focus on expediting time-to-value. It's not just our goal to immediately deliver greater returns on your investment in us as a partner—it's our reputation. ​

QUICKER, EFFICIENT, AND AFFORDABLE. THAT'S IMPRESIV!