Utilization Management Analyst

CommonSpirit Health • Santa Cruz, CA

9h

About The Position

The incumbent in this position supports the design, implementation and maintenance of clinical quality and outcome analytical systems for the Utilization Management Hub. This position provides technical support, statistical analysis and report generation. This position will focus on the retrieval of financial and clinical information at the patient level, including summarization of results to identify underlying trends. This position requires an expert understanding of medical record data, risk/severity adjustment systems and clinical as well as population based research methodologies. The incumbent will be required to collaborate with the System Care Coordination Leadership, Hospital Care Coordination Leadership, Utilization Management Hub Leadership, Quality Management and various other departments in the production of indicators and reports which incorporate measures of utilization management, clinical denials and department productivity. Ensure that all actions taken and methods used to produce the results outlined above incorporate and promote the Mission and Philosophy of CommonSpirit Health. The incumbent will be responsible for supporting the structures and processes necessary for providing clinically based health care information and analytic resources for clinical quality and performance improvement. Provide comprehensive planning assignment implementation, management and evaluation of assigned projects to meet the goals and objectives of Utilization Management and other departments as appropriate. Prepare written reports and make oral presentations as requested. Demonstrate initiative and personal accountability for actions using judgment and insight to solve problems and find better or more efficient ways to do things. Holds self and other accountable for ethical behaviors. Adapts to change, recognizes and appreciates the value of differing perspectives, develops innovative ideas and solutions, modifies plans and objectives given changing priorities or environment.

Requirements

• Bachelor's Degree or equivalent combination of applicable experience and education may be accepted at the hiring manager's discretion
• A minimum of three years analytical experience using analytical tools, computers, and databases supporting the Case Management department
• Strong database management experience
• Relevant healthcare experience
• Strong critical thinking skills to problem solve and develop/implement solutions
• Proficiency with establishing and maintaining relational databases
• Proficiency with personal computer operations and software (i.e. Google docs, Google sheets, Google slides, Word, Excel, PowerPoint)
• May include the use of Access, StrataJazz, MS4, Artiva and Midas
• Effective verbal and written communication including correct English usage (spelling, grammar and punctuation) to effectively communicate with individuals at all levels and from all backgrounds
• Good cognitive and interpersonal skills
• Fluency in use of database and multiple automation tools
• Perform basic arithmetic and statistical calculations
• Computer skills including data entry, retrieval and analysis
• Chart analysis, abstracting chart information
• Knowledge of regulations pertaining to confidentiality and the release of patient information along with TJC standards, DHS regulations, hospital requirements as they pertain to medical records

Nice To Haves

• Clinical experience with quality assurance/improvement
• Experience in utilization management, case management, and or managed care

Responsibilities

• Supports the design, implementation and maintenance of clinical quality and outcome analytical systems
• Provides technical support, statistical analysis and report generation
• Retrieval of financial and clinical information at the patient level, including summarization of results to identify underlying trends
• Collaborate with various departments in the production of indicators and reports which incorporate measures of utilization management, clinical denials and department productivity
• Supporting the structures and processes necessary for providing clinically based health care information and analytic resources for clinical quality and performance improvement
• Provide comprehensive planning assignment implementation, management and evaluation of assigned projects
• Prepare written reports and make oral presentations as requested

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level