Utilization Management Program Analyst

About Curative

Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent $150M in Series B funding and valuation at $1.275B Curative is scaling rapidly and investing in AI-powered service deeper member engagement and a smart network designed for todays workforce.

Our north star guides everything we do: healthcare only works when people can actually use it. That belief drives every decision we make: from how we design our plan support our members to how we collaborate as a team.

If you want to do meaningful work with a team that moves fast experiments boldly and cares deeply Curative is the place to do it. Were growing fast and looking for teammates who want to help transform health insurance for the better.

SUMMARY
The Utilization Management Program Analyst supports the development implementation and ongoing optimization of the organizations utilization management (UM) program. This role partners with clinical leadership pharmacy medical policy and operational teams to evaluate prior authorization requirements support medical policy implementation maintain UM program documentation and analyze utilization trends. The position plays an important role in ensuring the effectiveness compliance and continuous improvement of the UM program by assessing approval and denial patterns supporting policy updates coordinating responses to regulatory and audit requests and assisting with cross-functional training initiatives.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Utilization Management Program Support

• Support the ongoing development implementation and evaluation of the Utilization Management program
• Analyze utilization trends and identify opportunities to add modify or remove procedure codes from prior authorization requirements
• Monitor and evaluate approval and denial rates utilization patterns and cost trends
• Conduct cost and utilization analyses to assess the impact of UM policies and program changes
• Provide data-driven insights to support program improvements and operational decision-making

UM Policy & Program Documentation

• Support the maintenance and periodic updates of UM policies and procedures
• Assist with updates to the Utilization Management Program Description including annual review and revisions
• Ensure alignment between UM policies medical policies and prior authorization requirements
• Coordinate internal review and documentation of policy updates with relevant stakeholders

Medical Policy Implementation

• Support implementation of facility medical policies within UM processes and workflows
• Collaborate with clinical and operational teams to ensure policies are operationalized effectively
• Assist with communication and documentation related to policy changes

Regulatory & Audit Support

• Coordinate responses to regulatory requests audits and external inquiries
• Maintain documentation supporting UM compliance and regulatory requirements
• Monitor regulatory updates that may impact UM policies or operational practices

Clinical Licensure & Compliance Tracking

• Track and maintain documentation for clinical licensure requirements related to UM activities
• Support compliance with state and regulatory requirements regarding clinical participation in UM processes

Training & Cross-Functional Collaboration

• Support development and coordination of training for pharmacy and medical teams
• Assist in creating training materials related to UM policies workflows and regulatory requirements
• Serve as a liaison between UM pharmacy clinical compliance and operational teams

Program Coordination

• Assist with coordination of UM program initiatives and projects
• Track deliverables timelines and implementation activities
• Support reporting and documentation related to UM program performance
• Assist department leadership with day-to-day team management and administrative tasks. Work adhering to US regulatory and Quality System requirements (21 CFR 820 etc).
• This position assumes and performs other duties as assigned.

QUALIFICATIONS
To perform this job successfully an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• Demonstrated ability to manage projects interpret data and communicate effectively with stakeholders.
• Familiarity with medical coding systems (CPT HCPCS ICD-10)
• Experience supporting prior authorization programs or utilization management processes
• Experience with data analysis reporting or cost/utilization analysis
• Strong organizational skills and attention to detail.
• Ability to work independently and take initiative.

EDUCATION and/or EXPERIENCE

• Bachelors degree in healthcare administration public health health policy business or related
  field 25 years of experience in utilization management healthcare operations medical policy or healthcare analytics
• Minimum of two years of experience in related role within a healthcare or medical management setting.

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while
performing the essential functions of this job. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions.

• While performing the duties of this Job the employee is regularly required to sit; use hands to handle or feel; talk; and hear.
• Specific vision abilities required by this job include close vision distance vision color vision peripheral vision depth perception and ability to adjust focus.
• This is a remote position
• The employee may regularly be required to lift and/or move up to: 25 LBS
• The noise level in the work environment is usually: Mild
• For this position the percentage of expected Travel is: 5% of the time

Perks & Benefits

• Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)

  • $0 copays and $0 deductibles (with completion of our Baseline Visit )

  • Preventive and primary care built in

  • Mental health support (Rula Televero Two Chairs Recovery Unplugged)

  • One-on-one care navigation

  • Chronic condition programs (diabetes weight hypertension)

  • Maternity and family planning support

  • 24/7/365 Curative Telehealth

  • Pharmacy benefits

• Comprehensive dental and vision coverage

• Employer-provided life and disability coverage with additional supplemental options

• Flexible spending accounts

• Flexible work options: remote and in-person opportunities

• Generous PTO policy plus 11 paid annual company holidays

• 401K for full-time employees

• Generous Up to 812 weeks paid parental leave based on role eligibility.