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Job Description

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 our MDHHS 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 Children’s 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.

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 Children's 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.

To Be Considered For This Position You Must

- Apply for this position online via NEOGOV; 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 employment should 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 registrar's signature.

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

Required Education And Experience

Education

Possession of a bachelor's 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 requiring documentation of services provided, patient progress, etc. (e.g. nursing/therapy services); or; two 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 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.

Alternate Education And Experience

Medicaid Utilization Analyst 9-12

Possession of a bachelor's degree in allied health, health education, health sciences, health 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.

Additional Requirements And Information

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.

Responsibilities

Employees will be provided computers to perform state work. Phones may also be provided for necessary communications. If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including:
- 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.

As a Condition of Employment: this position requires successful completion of a background investigation and a criminal records check. The Department of Health & Human Services reserves the right to close this posting prior to its original end date once a sufficient number of applications have been received. For information about this specific position, please email MDHHSVacancies@michigan.gov. 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. The use of artificial intelligence (AI) software of any kind is prohibited in all areas of the selection process; including, but not limited to, responses to application questions, and responses to interview questions or exercises. If you previously held status in this classification and departed within the last three (3) years, please contact Human Resources regarding your interest in a potential reinstatement. Reinstatement is not guaranteed or required.

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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.