Utilization Analyst

Kaiser Permanente; Downey (CA); On-site; USD 70,000 - 90,000; Part time

Benefits offered by this job

Health benefits

Job summary

Kaiser Permanente in Downey, CA is seeking a data management and analysis professional to coordinate and supervise data workflows for utilization management and related services. You will implement and refine data systems, ensuring accurate reporting and timely insights for various care programs.

Responsibilities include coordinating data collection, educating clinical and administrative staff on benefits and charges, and supporting claims review processes.

Qualifications

• Experience applying analytic techniques to hospital data.
• Strong analytic and verbal skills.
• Expertise with tracking, spreadsheets and mainframe-style systems.
• Knowledge of health plan benefits.
• Understanding of medical center operations and regional policy interpretation.
• Ability to work in a Labor/Management Partnership environment.

Responsibilities

• Coordinate and supervise data management, analyses and reporting for utilization management and related services.
• Provide timely utilization data and analytic support to internal teams and outside facilities staff.
• Educate patients, physicians and hospitals on covered benefits and charges.
• Assist members during claims review and coordinate authorized/non-authorized claims review.
• Document outside medical services and reinforce procedures for patients seen in outside emergency departments.
• May coordinate Air & Ground Transportation and Prospective Review Authorization Program.
• Coordinate and supervise claims and referral information.
• Provide information regarding member admissions to outside facilities.
• Maintain integrity of non-KFH utilization bed track system.
• Assist in scheduling patient appointments and coordinating care.

Skills

Analytic skills

Verbal communication

Data tracking

Spreadsheets

Mainframe experience

Health plan knowledge

Education

High School Diploma or GED

AA/BA preferred

Tools

Health data systems

Job description

Job Summary

Coordinates and supervises data management, analyses and reporting for KFH utilization management and Continuing Care Services, SCPMG, KFHP Outside Services management (i.e., day utilization at Outside facilities, and the Emergency Prospective Review Program and Air & Ground Transportation Program, using (implementing and refining) computerized data management systems and in manually maintained utilization data.

Essential Responsibilities

• Coordinates and supervises data and reporting needs, data collection process and data processing issues and provides timely utilization data and analytic support.
• Frequent contacts with other organizational units and outside facilities staff to obtain, verify and/or provide information, e.g., works with Regional Claims and outside hospitals to reconcile billing charges.
• Answers inquiries and educate patients, physicians and hospitals on covered benefits and charges.
• Provides information and assistance to Health Plan members during claims review process and coordinates authorized and non-authorized claims review.
• Documents outside medical services and reinforce procedures for patients seen in outside emergency department.
• May coordinate and supervise Air & Ground Transportation and Prospective Review Authorization Program.
• Coordinates and supervises claims and referral information.
• Provides information regarding member admissions to outside facilities.
• Maintain the consistency and integrity of the non-KFH utilization bed track computerized data management system.
• May assist in scheduling patient appointments and coordinating patient care.

Basic Qualifications

Experience

• N/A

Education

• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• N/A

Additional Requirements

• Experience applying analytic techniques and computer skills to hospital data.
• Strong analytic and verbal skills.
• Expertise with tracking, spreadsheets and graphic computer systems operating on PC mainframes.
• Knowledge of health plan benefits.
• Understanding of medical center operations, complex health systems, with the ability to quickly grasp regional policies, contract interpretation of out-of-plan medical services.
• Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications

• Health Connect experience a plus.
• Associate of Arts or Bachelors degree preferred.
• Mainframe preferred.

Notes

• Alternating weekends.
• This is a temporary position for approximately three (3) months.