Utilization Management Program Analyst

Job Summary

The Utilization Management (UM) Program Analyst will support the compliance oversight in UM to ensure adherence to regulatory standards set forth by Centers for Medicare and Medicaid Services (CMS) programs. The role includes participating in UM program audits, assisting in the implementation of compliance initiatives, and supporting staff in maintaining adherence to CMS guidelines.

Must be located in Pacific Time, preferably near one of our office locations in Tustin, CA or Las Vegas, NV.

Key Responsibilities:

• Responsible for analyzing UM data, information analysis and reports to ensure compliance of Medicare and Medicaid programs specifically for Utilization Management.
• Participate in audits and monitor compliance with CMS regulations, policies, and reporting requirements.
• Collaborate with the Compliance Department and other teams to support the review and updating of policies, procedures, and practices.
• Provide support in training staff on compliance requirements and best practices.
• Assist in researching and resolving compliance issues and concerns related to CMS and State guidelines.
• Prepare and assist in the submission of compliance reports to clients and the Compliance Department as needed.
• Stay informed about changes in CMS regulations and guidelines, supporting the timely implementation of updates.
• Act as a support point of contact for compliance issues related to UM.
• Assist in the review and preparation of responses to Correction Action Plans (CAPs) and other audit findings.
• Support in the research and analysis of regulatory requirements, legislative changes and organizational initiatives.
• Take a lead role in the development, maintenance and publishing of internal/external policies and procedures.

What You'll Need:

• Basic understanding of CMS regulations, policies, and reporting requirements related to Medicare and Medicaid guidelines.
• Experience with Microsoft Office tools (Outlook, Excel, Word, SharePoint, PowerPoint) required.
• Strong analytical skills with attention to detail, and the ability to interpret regulations and guidelines.
• Good organizational and prioritization skills.
• Excellent communication and interpersonal skills, with the ability to work effectively in a team environment.
• Familiarity with compliance programs and auditing processes is a plus.
• Knowledge of HSP or Meditrac is a plus.
• Minimum 4-year bachelor's degree in healthcare administration, Public Health, Business Administration, or a related field, or equivalent combination of education and relevant work experience.
• Minimum 2 years' experience in utilization management or healthcare compliance, specifically focused on CMS Medicaid and Medicare guidelines.

Location

Our employees are distributed in office locations in multiple markets across the United States.  We are unable to hire or allow employees to work outside of the United States.

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their society. That’s why Liberty offers competitive and attractive benefit packages for their employees. We strive to care for employees in positive ways that promotes wellness and productive employees.

Our first-class benefit package supports our employees and their dependents with:

• Competitive pay structure and saving options that help you reach your financial goals
• Excellent 401k retirement benefits available which includes employer match and ability to save via a Roth IRA, plus immediate vesting during Safe Harbor period and professional financial advice through Financial Engines!
• Medical insurance offered with low-cost premium for employee only coverage and Liberty subsidizes 50% of dependent coverage for eligible enrolled dependents.
• 100% employer paid dental coverage for employees and eligible dependents.
• 100% employer paid vision coverage for employee only coverage, low-cost premium for dependents!
• Company paid basic life and AD&D coverage; options to elect additional supplemental coverage.
• Long Term Disability coverage
• Expansive wellness program including companywide Get Active challenges and Burn-A-Long with option for gym discounts.
• Employee Assistance Program
• Generous vacation and sick leave with the ability to roll time over.
• 10 paid company holidays
• Tuition Reimbursement
• Remote or Hybrid options for various positions
• And so much more...

Compensation

In the spirit of pay transparency, we are excited to share the base salary for this position is $58,760 - $80,000, exclusive of fringe benefits or potential bonuses.  If you are hired at Liberty, your final base salary compensation will be determined based on factors such as geographic location, skills, education, and/or experience.  In addition to those factors – we believe in the importance of pay equity and consider internal equity of our current team members as a part of any, final offer.  Please keep in mind that the range mentioned above is the full base salary range for the role.  Hiring at the maximum of the range would not be typical in order to allow for future & continued salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. 

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. 

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.