Clinical Services Optimization Business Analyst III

Clinical Services Optimization Business Analyst III

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

This analyst will work within Medica's Clinical Services Optimization division, specifically focused on electronic prior authorization business delivery. The analyst role is responsible to gather, research, document requirements, and maintain daily operations of ePA. This role collaborates with partners from cross-functional business areas, like network, Tech, and claims operations.

Key Accountabilities

• Analyst for ePA delivery
• Support daily delivery of ePA workflow
• Including but not limited to : process efficiency, error handling, business validation & UAT
• Ensures systems and processes are working as designed, evaluates system processes and procedures, evaluates requests for changes to the system, develops recommendations to solve problems and issues related to business system and reporting
• Reduces manual processes and duplication by implementing automation and standardized practices
• Oversight of ePA delivery process, workflow, and execution. Including : internal and external UM
• Research and speak expertly regarding the functionality of our clinical documentation system; includes providing support as the system subject matter expert within business and project teams
• Drives recommendations and process improvement efforts with stakeholders and facilitates decisions by listening to and collaborating with business stakeholders
• Interpret customer needs, translating them into application and operational requirements

Required Qualifications

Skills And Abilities

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations : Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $77,100 - $132,200. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $77,100 - $115,710. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and / or licensure, the position's scope and responsibility, internal pay equity and external market salary data.

In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

Eligibility to work in the US : Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

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