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Utilization Management Clinical Analyst Jobs in Wisconsin

Finance Manager, Clinical FP&A

Madison, WI ยท On-site

$88K - $152K/yr

... resource utilization. * Assess the financial impact of new clinical programs, services, and ... Maintain strong financial controls and risk management practices. * Assist in implementing and ...

RN Field Case Manager

Milwaukee, WI ยท On-site

$76K - $97K/yr

Bachelor's degree in Nursing preferred. * 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience * Knowledge of utilization ...

WI ยท On-site

$80 - $100/hr

Achieve instrument sales targets, grow assay and reagent utilization, and ensure customer retention ... Provide prompt and accurate sales forecasts, activity, account updates and reports via CRM system.

New

Demonstrates knowledge of risk management, clinical precautions, infection control, fall prevention, utilization of special procedures, environmental checks, fire disaster procedures, and ...

Showing results 41-60

Utilization Management Clinical Analyst information

What does a utilization management clinical analyst do?

A Utilization Management Clinical Analyst reviews and analyzes medical records, claims, and treatment plans to ensure that healthcare services provided to patients are medically necessary and cost-effective. They work with healthcare providers, insurance companies, and patients to evaluate the appropriateness of medical care based on established guidelines and policies. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulatory standards.

What are the key skills and qualifications needed to thrive as a utilization management clinical analyst?

To thrive as a Utilization Management Clinical Analyst, you need a solid background in healthcare, strong analytical abilities, and credentials such as RN or LPN licensure or relevant clinical certifications. Familiarity with utilization management software, electronic health records (EHRs), and claims processing systems is typically required. Excellent communication, critical thinking, and attention to detail are soft skills that help you collaborate effectively and make sound clinical determinations. These competencies are crucial for ensuring the appropriate use of medical resources, maximizing patient outcomes, and maintaining regulatory compliance.

How does a utilization management clinical analyst typically collaborate with clinical and administrative teams to ensure optimal patient care?

A Utilization Management Clinical Analyst works closely with both clinical staff, such as nurses and physicians, and administrative teams to review patient cases and ensure that treatments and services are medically necessary and align with payer guidelines. This role often involves participating in interdisciplinary meetings, communicating findings and recommendations, and helping to develop or refine care protocols. Effective collaboration is essential to balance quality patient care with cost efficiency, and analysts regularly provide feedback and support to improve clinical workflows and documentation.

What is the difference between Utilization Management Clinical Analyst vs Utilization Review Nurse?

AspectUtilization Management Clinical AnalystUtilization Review Nurse
CredentialsHealthcare degree, certifications like CCM or CUCRegistered Nurse (RN), state licensure, certifications like CCM
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, insurance companies, outpatient facilities
Employer & IndustryHealth insurance providers, managed care organizationsHospitals, insurance companies, healthcare facilities
Common Search & ComparisonUtilization Management Clinical Analyst vs Utilization Review Nurse

The main difference between a Utilization Management Clinical Analyst and a Utilization Review Nurse lies in their focus and credentials. Clinical Analysts often have healthcare degrees and certifications like CCM, working primarily in insurance or managed care settings. Utilization Review Nurses are registered nurses with licensure, working in hospitals or outpatient facilities. Both roles involve reviewing medical necessity, but their work environments and professional backgrounds differ.

What are popular job titles related to Utilization Management Clinical Analyst jobs in Wisconsin?

For Utilization Management Clinical Analyst jobs in Wisconsin, the most frequently searched job titles are:

What cities in Wisconsin are hiring for Utilization Management Clinical Analyst jobs?

Cities in Wisconsin with the most Utilization Management Clinical Analyst job openings:

Clinical Operations Manager II

FTCRUMAD Fortrea Clinical Research Unit Inc.

Madison, WI โ€ข On-site

$95 - $125/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New


Key responsibilities

  • Supervise and manage the performance of assigned direct reports, including conducting performance reviews and development plans.

  • Ensure regulatory training compliance, maintain training records, and escalate issues until resolution.

  • Monitor workload, billable hours, and resource allocation of staff, and assist with staff recruitment and expense management.


Job description

As one of the largest Clinical Research Organizations in the world, we have four Early Phase Clinical Research Units in the UK and US. We are currently seeking a Manager, Clinical Operations II, to interact directly with our healthy volunteer participants while learning to read clinical research protocols and enjoy working in a fast-paced team-oriented environment. Each day is different, you will be exposed to a wide variety of Therapeutic Indications and study types (ascending dose, first-in-human, food effect, drug to drug interactions, etc.) This is a full-time, office/clinic-based job in Madison, WI. If you join us, you will work with some of the worldยดs leading pharmaceutical, biotechnology, and medical device companies in a vital stage of clinical development: establishing the safety, tolerability and pharmacokinetics of a new drug. Many are drawn to this profession because of its direct impact on patient care. If this is your case, you will not miss that working in Phase 1 trials. Whilst allowing you to have a close face-to-face relationship with participants, and as you continue to practice your clinical skills and knowledge, youยดll be involved with the latest medical technologies and treatments, witnessing their development firsthand. When the drug you worked with gets approved, you know youยดll touch many patientยดs lives around the world.

WHAT YOU WILL DO:

Responsible for the supervision of assigned direct reports within PI MS. Responsible for detailed performance review and management of assigned direct reports including Annual Performance Management and Development (PMD) and Individual Development Plan (IDP). Responsible for appropriate management and resolution of performance issues. Effectively communicate management strategies, policies, and procedures in conjunction with leadership teams. Develop and maintain effective relationships with the management team to manage assigned staff in a matrix environment. Maintain good working relationships with internal and external clients to ensure opportunity for acquiring additional new business. Other key responsibilities: Has regulatory oversight of direct reports by ensuring regulatory training is executed, understood and implemented. Escalate issues and follow them till proper resolution. Ensures training record compliance with training matrix and ensures training records are up to date. Provide input to relevant SOPs and stand plans/templates with applicable. Assist with coordination and implementation of on-boarding of new direct reports ensuring GCT training before study-related activities begins. Hold staff accountable for issue escalation to the management team, the sponsor and QA as appropriate and determine regional implications for corrective action plans. Hold staff accountable for quality and compliance with project plan and adherence to contract obligations. Coach staff to own effective Investigation relations and Investigator oversight when applicable. Report status of assigned workload of direct reports and ensure allocation reports are updated. Perform weekly review of direct report billable hours and utilizations (in context of project allocation supply and demand); escalade of outliers and assists management team for mitigation. Adheres to global tools for monitoring and utilization forecasting. Assist with staff recruitment through screening and interviewing. Financial authority in accordance with current signature approval matrix Accountable for expense management, expense report approval and compliance with Travel Policy of direct reports. Liaise with internal and external customers in relevant process improvement initiatives. Encourages use of standardized processes and tools in alignment with associated policies to ensure efficiency and productivity. Support the company/department processes (e.g., Quality Control Visits). Identify, develop, and implement measures to improve the efficiency of the department. Responsible for staff time management, PTO and salary reviews. Might be requested to work in a client facing environment. All other duties as needed or assigned.

YOU NEED TO BRINGโ€ฆ
  • University/college degree (life sciences preferred) or certification in a related allied health profession from an appropriately accredited institution (e.g., nursing certification, medical or laboratory).
  • 5 years of direct Clinical research experience or combined with other relevant experience (i.e., worked as a Clinical Team Leader/Project Manager at a Pharma or CRO).
  • Individual proficiency with managing direct reports or equivalent combination of education and experience to successfully perform the key responsibilities of the job.

The important thing for us is you are comfortable working in an environment that is: Fast paced: where no deviations from the study protocol are allowed, and not meeting a timeline for even few minutes will create a quality issue. Changing priorities constantly asking you to prioritize and adapt on the spot. Teamwork and people skills are essential for the study to run smoothly. Technology based. We collect our data directly into an electronic environment.

What do you get?

Regular, full-time or part-time employees working 20 or more hours per week are eligible for comprehensive benefits including but not limited to:

  • Medical
  • Dental
  • Vision
  • Life
  • STD/LTD (multiple insurance carriers)
  • 401(K)
  • Paid time off (PTO)
  • Employee recognition awards
  • Multiple ERGโ€™s
Physical Requirements:

Mandatory immunizations and screening as required. Handling of biologically hazardous and radiolabeled material is necessary. Must be able to see (distinguish colors) and hear to meet, if necessary, the job requirements. Must have excellent command of the English language, both oral and written. Must be able to use hands to finger, handle, or touch objects, tools or controls, including a computer keyboard, for up to 6 hours per day. Must be able to stand and/or bend for up to 6 hours per day. Overtime and weekend work as required.

Travel Requirements:

less than 5% of the time for potential cross-site support needs or external training needs.

Learn more about our EEO & Accommodations request here.

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