Utilization Management Director jobs in Minnesota

Title: Registered Nurse - Utilization Management

Duration: 12 months (Possible Extension)

Location: Eagan, MN 55122 (Hybrid)

Job Description:

LOCAL candidates with ability to work onsite as needed (up to 2 days per week) is highly preferred.

RN with strong understanding of medical policy development and coding experience.

Business Analyst - Utilization Management

How Is This Role Important to Our Work?

The selected resource will support the evaluation of the prior authorization list by line of business.

This position is responsible for the analysis, development, support, reporting and coordination of business workflow automation and to implement efficient business processes at an enterprise level.

A Day in the Life:

• Use the existing prior authorization calculator tool to make recommendations on prior authorization list changes
• Intake and review list suggestions and inquiries from stakeholders
• Support completion of business case documentation to align with changes that come out of evaluation process
• Shephard the business cases through the various committee approvals to implementation
• Conducts in-depth research and analysis.
• Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.
• Documents metrics and process changes.
• Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.
• Participate in and coordinate individual projects and related activities to ensure project progresses on schedule.
• Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.
• Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.
• Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.
• Serves as senior subject matter expert associated with content, processes, and procedures.
• May lead project teams and may provide training to staff to achieve project milestones and objectives.

Required Skills and Experiences:

• 5 years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Registered Nurse with strong understanding of policy development and coding
• Advanced collaborative, interpersonal, oral and written communication skills and demonstrated ability to develop accurate and appropriate communications.
• Advanced ability to communicate to all levels of management.
• Advanced research, analytical and problem solving skills.
• Advanced skills in Microsoft Excel, Word, and Access.
• Strong ability to make decisions based on analysis and business needs.
• Advanced ability to bring a different perspective to situations and challenge the status quo.
• Project management skills.
• Proven ability to work independently with guidance in only the most complex situations.

Nice to Have:

• Bachelor's degree.
• Working knowledge of SAP, Visio, or other software programs.
• Bachelor's or Master s degree in a health-related field, such as nursing.

Release Comments: Business Analyst - Utilization Management