Utilization Management Analyst

Santa Barbara Cottage Hospital; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A major healthcare provider in the United States is seeking an analyst to support the design and implementation of clinical quality systems. The ideal candidate must have a Bachelor's degree and at least three years of analytical experience, particularly in healthcare. Responsibilities include statistical analysis, technical support, and report generation. Proficiency in database management and strong communication skills are essential. The role involves collaboration across departments to enhance utilization management processes.

Qualifications

• Minimum of three years analytical experience using analytical tools and databases.
• Proficiency in personal computer operations, including MS Office and database software.
• Knowledge of regulations regarding patient information confidentiality.

Responsibilities

• Support the design and maintenance of clinical quality analytical systems.
• Provide technical support and statistical analysis for utilization management.
• Collaborate with various departments to produce indicators and reports.

Skills

Analytical experience

Database management

Critical thinking

Effective communication

Education

Bachelor's Degree

Tools

Google Docs

Excel

Access

Job description

Where You’ll Work

Dignity Health, one of the nation’s largest health care systems, is a 22-state network of more than 9,000 physicians, 63,000 employees, and 400 care centers, including hospitals, urgent and occupational care, imaging and surgery centers, home health, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high-quality, and affordable patient-centered care with special attention to the poor and underserved..

One Community. One Mission. One California

Job Summary and Responsibilities

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.

Job Requirements

Minimum:

• 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

Preferred:

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