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. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.
This analyst will work within Medica’s Clinical Services Optimization division, specifically focused on electronic prior authorization business delivery. The analyst role is responsible to gather, research, document requirements, and maintain daily operations of ePA. This role collaborates with partners from cross-functional business areas, like network, Tech, and claims operations. They will manage the process from requirements gathering through delivery, including maintenance and validation. They will operationalize regulatory and/or business requirements, including process improvement and work related to growth initiatives. This role 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
- Including but not limited to: process efficiency, error handling, business validation & UAT
- Ensures systems and processes are working as designed, evaluates system processes and procedures, evaluates requests for changes to the system, develops recommendations to solve problems and issues related to business system and reporting
- Reduces manual processes and duplication by implementing automation and standardized practices
- Oversight of ePA delivery process, workflow, and execution. Including: internal and external UM
- Research and speak expertly regarding the functionality of our clinical documentation system; includes providing support as the system subject matter expert within business and project teams
- Drives recommendations and process improvement efforts with stakeholders and facilitates decisions by listening to and collaborating with business stakeholders
- Interpret customer needs, translating them into application and operational requirements
- Cross functional Collaboration
- Work cross functional with busi