Remote Utilization Review Rn Jobs in Stillwater, MN

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You'll Have As a Senior Workforce Planning Analyst, you will serve as the strategic workforce planning lead for Case Management and Utilization Management operations.
In this role, you will be responsible for developing workforce forecasts, capacity plans, staffing models, and operational analytics that support complex healthcare workflows. You will partner closely with operational leaders to forecast workload demand, evaluate workforce capacity, identify operational risks, and deliver staffing recommendations that support service, quality, regulatory, and financial objectives.
As an ideal candidate, you will possesses a blend of back-office workforce planning expertise, workforce management experience, and strong technical and analytical skills. Experience forecasting inventory-based work, multi-stage operational workflows, and healthcare operations is highly valued.
While this role is fully remote, we welcome all qualified applicants; however, preference will be given to candidates currently located in Minnesota. What You'll Do

• Engage and partner with key stakeholders to develop capacity plans and forecast models to meet business goals, customer needs and financial commitments.
• Provide actual and normalized forecast projections to vendors and schedulers.
• Analyze and interpret historical call and inventory data to identify trends, patterns, and opportunities for the business.
• Collaborate with WFM team to proactively recommend training, time-off, overtime, etc. based on the analysis of schedules and performance reports to uncover opportunities for efficiency.

How You'll Do It

• Responsible for updating and maintaining operations call-volume and work inventory patterns that accurately validate forecasting methods.
• Compose, lead and present weekly reviews of forecasts, capacity plans, shrinkage, and Key Performance Indicator (KPI) results and trends.
• Develop resolutions to complex problems that frequently require advanced competency in WFM metrics and analysis, with an emphasis on back-office work loads.
• Works closely with project team(s) to assess the impact of projects and initiatives on forecasts and the ability to deliver on set timelines provided.
• Stay curious and keep up to date on the latest best-in-class workforce management solutions and methodologies.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

• 5+ years of related customer service/operations support professional experience.
• Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.
• Ability to work weekend shifts and holidays on occasion.

Preferred Skills & Experience

• Experience supporting back-office, inventory-based, or workflow-driven operations where work is managed through queues, backlogs, cases, or work inventories.
• Advanced Microsoft Excel skills, including Power Query, PivotTables, data modeling, and complex formulas.
• SQL proficiency, including querying, joining and analyzing large datasets.
• Experience with NICE CXone and/or NiCE IEX
• Healthcare operations experience, such as Case Management, Utilization Management, Prior Authorization, Claims, Appeals, or Care Management.
• Power BI or other business intelligence and dashboarding tools.
• Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
• Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.
• Understanding of health care industry.
• Knowledge of business, operational and procedural knowledge of operations environments, and ability to identify improvements.
• Ability to define problems, collect data, conduct accurate analysis, prepare reports, and draw valid conclusions.

Role Designation Teleworker

Role designation definition:

• Teleworking is working full time remote.
• Hybrid is a minimum of 2 days onsite.
• Onsite is full-time onsite.

Compensation and Benefits $79,100.00 - $104,800.00 - $130,500.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance

• Life insurance

• 401k

• Paid Time Off (PTO)

• Volunteer Paid Time Off (VPTO)

• And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Physical requirements.