Utilization Management Analyst

Overview

Our mission is Better Health. Our passion is helping others.

What's Your Why?

• Are you looking for a career opportunity that will help you grow personally and professionally?

• Do you have a passion for helping others achieve Better Health?

• Are you ready to join a growing team that shares your mission?

Why Join Our Team: At Better Health Group, it's our commitment, our passion, and our culture that sets us apart. Our Team Members make a difference each and every day! They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients. We don't just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive, and start living your purpose at Better Health Group.

Responsibilities

Position Objective:

The Utilization Management Analyst is an administrative role and is responsible for gathering, interpreting, and using complex data to develop actionable steps that will improve processes and optimize results. The analyst is responsible for assessing company and client needs, reviewing robust information, analyzing, and looking for trends or areas for improvement.

Responsibilities:

• Analyze healthcare data to identify trends and opportunities for improvement in the utilization of services
• Prepare and deliver high-level reports and presentations to senior leadership, providing insights on utilization metrics, highlighting areas for cost savings and quality improvements
• Develop and implement utilization review processes to ensure compliance with regulatory standards and organizational goals
• Work with insurance providers to manage pre-authorizations, post-service claims, and other aspects of utilization management
• Maintain up-to-date knowledge of industry trends, best practices, and regulatory requirements related to utilization management
• Analyze healthcare utilization patterns and work with medical management teams to identify opportunities for optimization and resource allocation improvements
• Partner with internal departments to drive key strategic initiatives that impact the utilization management and medical economics
• Utilize data and analytics to inform decision-making, providing insights that drive strategic initiatives
• Produce monthly reports timely
• Additional duties as assigned

Position Requirements/ Skills:

• Bachelor's degree in Healthcare Administration, Economics, Finance, Business Administration or Management, or a related field
• 5+ years of relevant healthcare economics or medical cost management experience
• Strong knowledge of healthcare regulations, policies, and industry trends
• Strong financial and analytical skills, with the ability to analyze complex healthcare data and derive actionable insights
• Proficient in various data analytics software and tools such as SQL, PowerBI, PowerPivot, PowerQuery, VBA
• Advanced Excel and macro experience required
• Proficient with Google Suite (Drive, Gmail, Docs, Sheets, Slides) for real-time collaboration

• Strong interpersonal and presentation skills
• Strong quantitative abilities and ability to deliver actionable insights
• Solve complex problems and recommend organizational solutions
• Excellent written and verbal communication skills; must be comfortable communicating with internal/external stakeholders, providers, and health plans
• Demonstrated resourcefulness, initiative, and results-oriented capabilities
• Ability to work cross-functionally with multiple teams; able to work independently with minimal supervision
• Excellent organizational, time-management, and multi-tasking skills with strong attention to detail
• Strong critical thinking and problem-solving skills
• Must be results-oriented with a focus on quality execution and delivery
• Demonstrated ability to handle data with confidentiality
• Appreciation of cultural diversity and sensitivity toward target patient populations

Physical Requirements:

• Physical ability to sit, stand, and move freely about the office
• Must be able to remain in a stationary position up to or exceeding 50%
• Ability to stand, walk, and sit for long periods of time; ability to climb stairs
• Ability to bend, stoop, kneel, squat, twist, reach, and pull
• Constantly operates a computer and other office productivity machinery, such as copy machine, and computer printer
• Ability to sit for extended periods of time

Key Attributes/ Skills:

• Has a contagious and positive work ethic, inspires others, and models the behaviors of core values and guiding principles
• An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments
• Is able to work within the Better Health environment by facing tasks and challenges with energy and passion
• Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals

Local candidate highly preferred. Hybrid work schedule (In office/Remote). If remote, travel will be required, specifically to Tampa, FL.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Pay Range

USD $56,800.00 - USD $85,200.00 /Yr.