Hybrid Utilization & Pre-Authorization Analyst

Healthez Inc; Minneapolis (MN); On-site; USD 73,000 - 85,000; Full time

Job summary

HealthEZ is seeking a detail-oriented Utilization and Pre-Authorization Analyst to support utilization review and pre-authorization within the Medical Management team. You will collaborate with internal and external stakeholders to ensure efficient, accurate, and compliant healthcare service delivery.

This hybrid role requires onsite presence three days per week and remote two days. Reporting to the Director of Clinical Operations, you will translate requirements into clear authorization rules,

Qualifications

• Bachelor's degree in health sciences or related field with 3+ years of progressive healthcare experience.
• Experience in prior authorization, utilization management, clinical operations, and health plan operations.
• Ability to translate requirements into clear business rules and documentation standards.
• Strong understanding of authorization workflows, service categories, documentation requirements, and routing logic.
• Experience maintaining inventories, rule libraries, logs, trackers, or governance documents with version control.
• Proven ability to work with IT, vendors, Medical Management, Clinical Operations and stakeholders to resolve gaps.

Responsibilities

• Translate clinical, regulatory, vendor and operational requirements into clear authorization rules.
• Establish documentation standards, testing scenarios and governance processes.
• Collaborate across Medical Management, Clinical Operations and IT.
• Establish and maintain vendor relationships and delegated UM partners.
• Organize complex information, identify gaps, maintain version control.
• Support both implementation readiness and long-term operations sustainability.

Skills

Prior authorization

Utilization management

Clinical operations

Health plan operations

Documentation standards

Routing logic

Vendor & IT collaboration

Analytical & organizational skills

Communication skills

Version control

Education

Bachelor's degree in health sciences

Associate's degree with 4+ years of experience

Job description

HealthEZ is seeking a detail-oriented Utilization and Pre-Authorization Analyst to support utilization review and pre-authorization within the Medical Management team. You will collaborate with internal and external stakeholders to ensure efficient, accurate, and compliant healthcare service delivery.

This hybrid role requires onsite presence three days per week and remote two days. Reporting to the Director of Clinical Operations, you will translate requirements into clear authorization rules,