Medicaid Utilization Analyst 9-12 HSA Program Review Division

The MDHHS mission is to provide opportunities services and programs that promote a healthy safe and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity respect and fairness. For more information please visit ourMDHHS Diversity Equity and Inclusion Plan.

Medicaid Utilization Analyst 12
This position functions as a clinical review professional responsible as the senior analyst conducting clinical reviews of applications/requests for prior authorization of clinical services procedures supplies and/or equipment provided to Medicaid and Childrens Special Health Care Services beneficiaries and to provide technical assistance and consultation regarding services products technology and standards of coverage. These reviews require a more in-depth. analysis and do not fall within the standard parameters of the normal review process. This position may function in a liaison capacity and/or will consult with Office of Medical Affairs clinicians as needed. This position will participate as an alternate to assure operational turnaround time is met. The expertise of the position is relied upon for formation and interpretation of Medicaid policy to provide technical knowledge for coverage and service inquiries to advise on standards of coverage and to prepare summaries and testify at Administrative Hearings and Department Reviews. The position also serves as the consultant to other department staff vendors providers and beneficiaries for coverage decisions and policy coverage as well as providing training for less experienced/new division staff.
A-Level Position Description

Medicaid Utilization Analyst 9 to P11
This position functions as a clinical review professional responsible for conducting clinical reviews of applications/requests for prior authorization of clinical services procedures supplies and/or equipment provided to Medicaid and Childrens Special Health Care Services beneficiaries and to provide technical assistance and consultation regarding services products technology and standards of coverage. This position may rely on consultation with more senior staff for reviews of higher-than-normal complexity and will consult with Office of Medical Affairs clinicians as needed. This position will participate as an alternate to assure operational turnaround time is met. The day-to-day PA review experience of the position is relied upon to contribute information from provider submissions notifying senior staff responsible for formation and interpretation of Medicaid policy and provision of technical knowledge for coverage and service inquiries. This position also prepares summaries and testifies at Administrative Hearings and Department Reviews and provides basic consultation and information to address PA-related questions within BPHASA and to other departments and agencies seeking guidance from senior level staff as needed.
E-Level Position Description

Job Specification

To be considered for this position you must:

• Apply for this position online viaNEOGOV; click on Apply in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted.
• Relevant experience and/or education referred to in the supplemental questions must be documented in the resume transcript and/or application to allow for accurate screening.
• Attach a resume identifying specific experience and dates of employment. Dates of employmentshould include month and year and hours per week.
• Attach a cover letter.
• If applicable attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based internet or copies of unofficial transcripts. Official transcripts provide the name of the institution confirmation that a degree was awarded and on what date and the registrars signature.

Failure to complete any of the above items may result in your application not being considered. See instructions for attaching files here: Instructions

Education
Possession of a bachelors degree in audiology dental hygiene emergency medical technician medical records administration medical technology nuclear medicine technology nursing occupational therapy pharmacy physician assistant physical therapy radiologic technology rehabilitation respiratory therapy speech pathology or sports medicine.

Experience
Medicaid Utilization Analyst 9 - No specific type or amount is required.
Medicaid Utilization Analyst 10 - Two years of professional experience providing clinical patient care requiring documentation of services provided patient progress etc. (e.g. nursing/therapy services); or; one year of professional experience analyzing health services or health services utilization data equivalent to a Medicaid Utilization Analyst 9.
Medicaid Utilization Analyst P11-Four years of professional experience providing clinical patient care requiringdocumentation of services provided patient progress etc. (e.g. nursing/therapyservices); or; two years of professional experience analyzing health services or healthservices utilization data equivalent to a Medicaid Utilization Analyst including one yearequivalent to a Medicaid Utilization Analyst 10.
Medicaid Utilization Analyst 12 - Three years of professional experience analyzing health services or health services utilization data equivalent to a Medicaid Utilization Analyst including one year equivalent to a Medicaid Utilization Analyst P11.

Medicaid Utilization Analyst 9-12
Possession of a bachelors degree in allied health health education health scienceshealth care administration chiropractic health care management health systems management and health studies and licensure/certification in a clinical health care field may be substituted for the education requirement.

Medicaid Utilization Analyst 12
Two years of experience as a Registered Nurse P11 or equivalent may be substituted for the education requirement.

This posting is to hire several MUA 9-12 positions. Positions will be filled at the level candidate qualifies for.

The physical location of this position is Capitol Center Commons 400 S. Pine Lansing MI. Based on operational needs and within established limits remote work and alternate or hybrid work schedule requests for this position may be considered.

Selected candidates who have been approved to work remotely or a hybrid schedule must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview.

• A secure work location that allows privacy and prevents distractions.
• A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.
• Suitable lighting furniture and utilities.

For information about this specific position please email. Please reference the job posting number in subject line.

Your application for any position does not guarantee you will be contacted by the Department/Agency for further consideration. Only those applicants interviewed will be notified of the results.

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Accommodations
If you require a reasonable accommodation to participate in the application or selection processes please contact the ADA coordinator for the agency that posted this position vacancy.