Utilization and Pre Authorization Analyst

Healthez Inc; Minneapolis (MN); Hybrid; 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

The Opportunity

HealthEZ is seeking a detail-oriented and process-driven Utilization and Pre-Authorization Analyst with a proven track record of success in healthcare operations. As a key member of the Medical Management team, this role will support critical utilization review and pre-authorization functions while collaborating closely with internal and external stakeholders. Reporting to the Director of Clinical Operations, the Analyst will play an important role in ensuring efficient, accurate, and compliant healthcare service delivery.

This is a hybrid position, requiring onsite presence three days per week and offering the flexibility to work remotely two days per week.

What You Will Do

• Translate clinical, regulatory, vendor and operational requirements into clear authorization rules, service data.
• Establish documentation standards, testing scenarios and governance processes.
• Able to effectively work across different departments within the organization including Medical Management, Clinical Operations, IT.
• Establish and maintain vendor relationships and delegated UM partners.
• Ability to organize complex information, identify gaps, maintain version control.
• Support both implementation readiness and long-term operations sustainability.

Qualifications

• Bachelor's Degree in health sciences or related field with 3+ years of progressive experience in the healthcare industry or Associate's degree with 4+ years of progressive related experience.
• Experience in prior authorization, utilization management, clinical operations, health plan operations and delegated UM operations.
• Ability to translate clinical, regulatory, vendor, and operational 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 and effective dates.
• Proven ability to work effectively with IT, vendors, Medical Management, Clinical Operations and operational stakeholders to resolve gaps and drive decisions.
• Strong analytical, organizational, and communication skills with attention to detail and follow through.

We make healthcare EZ!

Additional Opportunity Details:

Target Base Compensation Range for this role is $72,500-$85,000*

• Factors that may be used to determine your actual salary include your job specific skills, education, training, job location, number of years of experience related to this role and comparison to other employees already in this role. *

Employee benefits are part of the competitive total rewards package that HealthEZ provides to you. Our comprehensive benefits program includes health benefits, retirement plan (401k), paid time off, paid leave including parental leave and more.

HealthEZ recognizes its responsibilities under federal, state and local laws requiring non-discriminatory employment practices. All employment decisions, practices and procedures will be carried out without regard to race, color, creed, religion and sex (including pregnancy), sexual orientation, national origin or ancestry, age, marital status, disability, family status, status with regard to public assistance or any other characteristic protected under applicable local, state and federal laws.

HealthEZ is proud to be an equal opportunity employer.