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Senior Analyst (1059241)

Remote: 
Full Remote
Contract: 
Salary: 
36 - 96K yearly
Experience: 
Mid-level (2-5 years)
Work from: 
Minnesota (USA), United States

Offer summary

Key responsabilities:

  • Oversee, lead end-to-end business processes
  • Identify improvement opportunities; conduct audits
  • Provide support for Prior Authorization, Appeals
  • Lead audit and regulatory support teams
  • Conduct data validation for quality control
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The Judge Group Human Resources, Staffing & Recruiting Large https://www.judge.com/
1001 - 5000 Employees
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Job description

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Your missions

Location: MINNEAPOLIS, MN, USA

Salary: $40.00 USD Hourly - $50.00 USD Hourly

Description

Job Title: Senior Analyst

Work Location: Remote

Duration: Contract

Responsibilities

  • Oversee end-to-end business process activities, focusing on creating, controlling, and improving performance guarantee processes related to Prior Authorization (PA) and Appeals.
  • Lead process design and project implementation teams to ensure program compliance and quality control, adhering to audit requirements for 19 states serviced by UHC Community and State.
  • Identify process improvement opportunities and develop solutions using principles of process excellence and related tools.
  • Conduct quality reporting, analysis, and audits, and develop plans and programs to support continuous quality improvement.
  • Assist in the creation, implementation, and evaluation of Total Quality Management (TQM) programs related to PA and Appeal performance guarantees.
  • Direct the design, facilitation, training, and evaluation of TQM incentive programs and oversee quality improvement projects and teams.

Prior Authorization Governance And Auditing Group

  • Provide audit and regulatory support related to PA and Appeals for all OptumRx clients.
  • Serve as the regulatory subject matter expert during oversight and delegation audits performed by various clients.
  • Analyze and report Out of Compliance (OOC) data, perform clinical reviews on DOI inquiries to ensure alignment with regulatory guidance.
  • Lead data validation efforts for PA and Appeals, ensuring quality control for adherence to accreditation, state, and federal program requirements.
  • Conduct clinical validation, reviewing prior authorization cases for clinical decision-making based on individual plan formulary requirements and patient demographics.
  • Ensure compliance with various regulations based on lines of business and plan design.
  • Identify process improvements to ensure compliance with state and federal laws, business contract requirements, and maintain client relations.
  • Analyze and investigate root causes of non-compliant cases.

Contact: kgregor@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Industry :
Human Resources, Staffing & Recruiting
Spoken language(s):
Check out the description to know which languages are mandatory.

Soft Skills

  • Problem Solving
  • communication
  • consultative-approaches
  • Adaptability
  • Teamwork