Clinical Services Optimization Business Analyst III

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We’re a team that owns our work with accountability, makes data‑driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It’s our mission to be there in the moments that matter most for our members and employees. This analyst will work within Medica’s Clinical Services Optimization division, specifically focused on electronic prior authorization business delivery. The analyst role is responsible for gathering, researching, documenting requirements, and maintaining daily operations of ePA. The role collaborates with partners from cross‑functional business areas, like network, Tech, and claims operations, and manages the process from requirements gathering through delivery, including maintenance and validation. It operationalizes regulatory and/or business requirements, drives process improvement, and supports growth initiatives. The analyst acts as our ePA clinical documentation system expert and liaises between Clinical Services and other business domains, Medica IT, clinical platform vendor, and reporting teams. Performs other duties as assigned. Key Accountabilities Analyst for ePA delivery

• Support daily delivery of ePA workflow
• Process efficiency, error handling, business validation & UAT
• Ensure systems and processes are working as designed; evaluate system processes and procedures; evaluate requests for changes; develop recommendations to solve problems and issues related to business system and reporting
• Reduce manual processes and duplication by implementing automation and standardized practices

Oversight of ePA delivery process, workflow, and execution, including internal and external utilization management (UM) Research and speak expertly regarding the functionality of our clinical documentation system; provide support as the system subject matter expert within business and project teams

• Drive recommendations and process improvement efforts with stakeholders and facilitate decisions by listening to and collaborating with business stakeholders
• Interpret customer needs, translating them into application and operational requirements

Cross‑functional collaboration

• Work cross‑functionally with business partners to achieve program delivery
• Create strong partner relationships to be successful
• Drive clinical and health service business readiness by leading for success strategies

Required Qualifications Bachelor’s degree or equivalent combination of education and related work experience 5+ years of related experience with 4+ years of experience working on large organizational projects Skills And Abilities Implementation and new capabilities delivery experience Computer proficiencies including Microsoft Office (Word, Excel, Access, Outlook, Visio, OneNote, Teams, etc.) and experience with other program functions (workflow, eligibility, claims, etc.) Ability to lead and be a good role model, influence change, shape and initiate work with colleagues across the organization and external (care systems, community collaborations, and vendors) to achieve department goals Excellent written and verbal communication skills with all levels of the organization Knowledge of computer applications such as Microsoft Project and Vision, Access, and familiarity with using database systems Managing/Delegating/Measuring Work: Ability to develop and assign clear, appropriate objectives, accountabilities and measures; monitor and report progress; identify and address barriers Quality focus: Commitment to continuous quality improvement in all aspects of work; skilled user of quality tools and techniques Experience setting expectation and direction for program delivery This position is an office role, requiring an employee to work onsite on average 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI. The full salary grade for this position is $78,700 – $134,900. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $78,700 – $118,020. Annual salary placement will depend on a variety of factors, including but not limited to education, work experience, applicable certifications and/or licensure, the position’s scope and responsibility, internal pay equity and external market salary data. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, holidays, paid volunteer time off, 401(k) contributions, caregiver services, and many other benefits to support our employees. The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law. Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment regardless of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic. #J-18808-Ljbffr Medica