IT Program Analyst - Utilization Management (Remote Option)

Position eligible for – 

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details. 

Office Location:  Available for the Gastonia, NC location; Remote Option

Projected Hiring Range:  Depending on Experience
Closing Date:  Open Until Filled

Primary Purpose of Position: Perform duties to provide support and be a technical liaison between Partners IT and Partners Utilization Management teams. This position is responsible for analyzing, documenting, solutioning and implementing appropriate technologies and systems to support Partners’ Utilization Management operations. This position is an extension of Partners’ IT working alongside the Utilization Management team to help ensure efficient and effective operations and use of appropriate technologies, in support of UM business and Partners goals and objectives.  

Roles and Responsibilities:  

• Systems Analysis: Evaluate and analyze behavioral and physical health, Utilization Management information technology, systems and reporting/analytics needs to ensure they meet operational goals and improve efficiency.
• Project Management: Lead and manage projects related to the implementation and enhancement of Utilization Management information systems and technology, ensuring on time completion and effective results. 
• Business Requirements: Create and/or document technical business requirements for use by developers, vendors, and business SMEs. Respond to required, timely, regulatory submissions. 
• Data Management: Collect, analyze, and present both behavioral and physical health, Utilization Management-related data to support the Program’s ability to make data driven decisions efficiently and effectively.  Collaborate with the Data Analysts to prepare requested Utilization Management reports and analytics as needed under the guidance of the UM leadership team.
• Collaboration: Work closely with Utilization Management leadership team, Program staff, clinical resources, delegated entities, and other stakeholders to identify and document system requirements and develop solutions. Serves as liaison and coordinates issues with vendor and IT technical support.
• Maintenance: Collaborate with stakeholders for planned or unplanned system upgrades, patches or enhancements. Monitors systems resources and documents patches, updates and/or hotfixes.
• Testing: Serve as primary point of contact for annual testing and tabletop exercises for Utilization Management related systems. Ensure systems meet requirements for SIT and E2E testing with the Department. Ensure regression testing is completed for all system updates and enhancements. Develop and execute test plans.
• Troubleshooting: Provide technical support and issue resolution related to the Utilization Management system, bother Program applications and electronic health record, to minimize systems and /or operations disruption.
• Training: work collaboratively to develop training programs for Utilization Management staff on new systems and processes and assist in the delivery of the training as necessary.
• Regulatory: Ensure system compliance with NCQA, SOC 2 Type 2, and other health plan required certifications.  Complies with all Federal and State rules, regulations, guidelines and standards pertaining to the use and communication of protected information including but not limited to, HIPAA and HITECH.
• Assist in other duties and tasks as needed or assigned. 

Knowledge, Skills and Abilities: 

• Excellent understanding of hardware technology, operating systems, network and communications, multi-tiered architecture and applications
• Knowledge in Utilization Management practices and procedures-including understanding of state and Federal laws related to Utilization Management practice, healthcare/medical terminology, medication names/general uses
• Ability to work closely with all levels of staff and present ideas and status clearly and professionally.
• Experience with Microsoft Word required, other Microsoft 365 suite of programs considered essential. Experience with Excel or other spreadsheet analytics software is required.
• Must be well organized, have demonstrated excellence in written and verbal communication skills, and proficiency in managing high stress situations with grace

    •    Ability to identify problems including complex multi-layered issues and determine potential solutions, both independently and as a team                   member, using critical thinking skills 

• Demonstrated excellence in customer service skills and strong analytical skills
• Self-motivated, self-starter

Education and Experience Required: Bachelor’s degree or equivalent experience in Information Technology, Computer Science, Utilization Management, Business or related field.  

Minimum of 3 years experience in systems/business analysis and project management. 

Education and Experience Preferred: Master’s degree in information technology, Computer Science, Utilization Management, Business or related field and five plus (5+) years’ experience in systems/business analysis and project management and: 

• Experience with Utilization Management information systems (e.g., Epic, HSP, McKesson).
• Experience with data visualization tools (e.g., Power BI, Tableau)
• Certification in project management (e.g., PMP (PMI)).