Utilization Analyst-UHW

Kaiser Permanente; Downey (CA); On-site; USD 39,000 - 83,000; Part time

Job summary

KAISER, located in Downey, CA, is seeking an Utilization Analyst-UHW to coordinate data management, analyses, and reporting for utilization management and related services. This role involves working with outside facilities, insurance steps, and incident reporting.

The position is part-time and temporary (approximately three months), requiring strong analytical and communication skills and familiarity with health plan benefits and mainframe/PC tools.

Qualifications

• Experience applying analytic techniques to hospital data.
• Strong analytic and verbal skills.
• Knowledge of tracking, spreadsheets and mainframe-oriented graphics tools.
• Knowledge of health plan benefits.

Responsibilities

• Coordinates and supervises data and reporting needs, data collection, data processing and provides timely utilization data and analytic support.
• Interacts with Regional Claims and outside hospitals to reconcile billing charges.
• Educates patients, physicians and hospitals on covered benefits and charges.
• Assists Health Plan members during claims review and coordinates authorization processes.
• Documents outside medical services and reinforces procedures for patients seen in outside ER.
• May coordinate Air & Ground Transportation and Prospective Review Authorization Program.
• Coordinates and supervises claims and referral information.
• Provides information regarding member admissions to outside facilities.
• Maintains non-KFH utilization bed track computerized data management system.
• Assists in scheduling patient appointments and coordinating patient care.

Skills

Analytic techniques

Verbal communication

Data tracking & spreadsheets

Health plan knowledge

Medical center operations

Labor/Management environment

Education

High School Diploma or GED

Associate or Bachelor degree (preferred)

Tools

Health Connect (preferred)

Mainframe experience

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.

• Preferred: KPHC - medical records, foundations / mainframe experience.

  Notes:

• This is a part time position, days and hours may vary.

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

COMPANY: KAISER

TITLE: Utilization Analyst-UHW

LOCATION: Downey, California

REQNUMBER: 1453172

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.