Be an early applicantLess than 25 applicants

Company

LIBERTY Dental Plan · 4 hours ago

Utilization Management Program Analyst

Tustin, CA

Full-time

Remote

Entry, Mid Level

$59K/yr - $80K/yr

2+ years exp

Maximize your interview chances

DentalInsurance

No H1B

Insider Connection @LIBERTY Dental Plan

Discover valuable connections within the company who might provide insights and potential referrals.
Get 3x more responses when you reach out via email instead of LinkedIn.

Responsibilities

Responsible for analyzing UM data, information analysis and reports to ensure compliance of Medicare and Medicaid programs specifically for Utilization Management.

Participate in audits and monitor compliance with CMS regulations, policies, and reporting requirements.

Collaborate with the Compliance Department and other teams to support the review and updating of policies, procedures, and practices.

Provide support in training staff on compliance requirements and best practices.

Assist in researching and resolving compliance issues and concerns related to CMS and State guidelines.

Prepare and assist in the submission of compliance reports to clients and the Compliance Department as needed.

Stay informed about changes in CMS regulations and guidelines, supporting the timely implementation of updates.

Act as a support point of contact for compliance issues related to UM.

Assist in the review and preparation of responses to Correction Action Plans (CAPs) and other audit findings.

Support in the research and analysis of regulatory requirements, legislative changes and organizational initiatives.

Take a lead role in the development, maintenance and publishing of internal/external policies and procedures.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

CMS regulationsUtilization managementHealthcare complianceMicrosoft OfficeHSPMeditrac

Required

Basic understanding of CMS regulations, policies, and reporting requirements related to Medicare and Medicaid guidelines.

Experience with Microsoft Office tools (Outlook, Excel, Word, SharePoint, PowerPoint) required.

Strong analytical skills with attention to detail, and the ability to interpret regulations and guidelines.

Good organizational and prioritization skills.

Excellent communication and interpersonal skills, with the ability to work effectively in a team environment.

Minimum 4-year bachelor's degree in healthcare administration, Public Health, Business Administration, or a related field, or equivalent combination of education and relevant work experience.

Minimum 2 years' experience in utilization management and healthcare compliance, specifically focused on CMS Medicaid and Medicare guidelines.

Preferred

Familiarity with compliance programs and auditing processes is a plus.

Knowledge of HSP or Meditrac is a plus.

Benefits

Competitive pay structure and saving options that help you reach your financial goals

Excellent 401k retirement benefits available which includes employer match and ability to save via a Roth IRA, plus immediate vesting during Safe Harbor period and professional financial advice through Financial Engines!

Medical insurance offered with low-cost premium for employee only coverage and Liberty subsidizes 50% of dependent coverage for eligible enrolled dependents.

100% employer paid dental coverage for employees and eligible dependents.

100% employer paid vision coverage for employee only coverage, low-cost premium for dependents!

Company paid basic life and AD&D coverage; options to elect additional supplemental coverage.

Long Term Disability coverage

Expansive wellness program including companywide Get Active challenges and Burn-A-Long with option for gym discounts.

Employee Assistance Program

Generous vacation and sick leave with the ability to roll time over.

10 paid company holidays

Tuition Reimbursement

Remote or Hybrid options for various positions

And so much more...