Medicaid Utilization Analyst 9-12 - Bphasa Medical Equipment & Services Section

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. (Download PDF reader)
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.
A-Level Position Description (Download PDF reader)
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.
E-Level Position Description (Download PDF reader)
Job Specification

To be considered for this position you must:

• Attach a resume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.
• 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.
• 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.
• 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.
• Attach a cover letter.

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

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.

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.

This posting is being used to fill 4 vacancies.
Position Location/Remote Office: This position will work remotely. Occasional travel to the office located at Capitol Commons Center 400 S Pine St, Lansing 48933 may be required.
Selected candidates who have been approved to work remotely must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview.
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:

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

For information about this specific position, please email [email protected]. 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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Vacation and Sick Leave: Eligible full-time employees receive between 15 and 35 personal days and 13 sick days per year that may be rolled over to the following year if not used. Eligible employees also receive an additional day each year for community service or school functions.

Paid Parental Leave: Eligible employees can take 12 weeks of paid leave immediately after a birth or adoption to allow needed time together at home with a new child.

Paid Holidays: Eligible employees receive 13 or 14 paid holidays each year including New Year’s Eve and Day, Martin Luther King Jr. Day, Presidents’ Day, Memorial Day, Juneteenth, the Fourth of July, Labor Day, Election Day, Veterans Day, Thanksgiving, Thanksgiving Friday, Christmas Eve and Day.

Bonus Programs: Eligible employees with five years of service also receive annual longevity bonuses that grow as seniority increases. Some positions also may qualify for recruitment, retention, and performance bonuses or other special pay premiums.

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Updated: 11/14/2022