Business Analyst- Utilization Management

Quartz Health Solutions is hiring a Business Analyst – Utilization Management to support and improve utilization management and referral-related system solutions. The role translates business needs into system configurations, testing, documentation, and operational improvements that support members, providers, and organizational goals.

Responsibilities:

• Analyze, design, configure, test, implement, and support Utilization Management (UM) and referral-related system solutions
• Partner with business stakeholders, IT teams, and vendors to define requirements, resolve issues, and implement system enhancements
• Serve as a subject matter expert for UM configuration, workflows, business processes, and related system functionality
• Maintain ownership of Prior Authorization, Referral, Criteria Review Software, referral correspondence, work queue configuration, reporting, and production support
• Develop and maintain business requirements, process documentation, policies, procedures, and test artifacts
• Perform validation and quality assurance testing of system configurations and changes to ensure accuracy and compliance with business requirements
• Analyze data discrepancies, identify root causes, and recommend process or system improvements
• Provide guidance, training, and mentorship to team members and support cross-functional project initiatives
• Participate in change management, implementation, and continuous improvement efforts to enhance operational efficiency and member/provider experience

Requirements:

• Knowledge of health insurance plans and application / utilization management
• 2+ years of experience in Business Analyst role or equivalent experience
• 2+ years of experience in prior support of systems including health insurance claims adjudication, eligibility, provider contracts, provider enrollment, EDI, or benefit plans
• Bachelor's or Associate's degree or related experience
• Advanced MS Office skills
• Developing fluency with tools such as BusinessObjects, Chronicles, Visio
• Strong verbal and written communication skills – able to effectively description ideas or difficult/ sensitive situations
• Ability to interact across team/departments to achieve project and department goals
• Ability to understand and discuss technical software issues with others
• Ability to adapt to changing circumstances, accepting uncertainty and/or unpredictability
• Experience working in an Epic – Tapestry strongly preferred