Utilization Management Solutions Analyst II

HMSA; Honolulu (HI); On-site; USD 80,000 - 110,000; Full time

Job summary

HMSA in Honolulu seeks an Analyst to support Medical Management (MM) by documenting reporting requirements and providing data analytics across HMSA systems. The role involves clarifying business questions, audience, and reporting scope, while maintaining regulatory reporting knowledge.

You will participate in system implementations, develop tools for Utilization Management, and coordinate with management on department activities.

Qualifications

• Solicit and document reporting requirements, clarifying business intent and audience.
• Maintain knowledge of regulatory reporting guidelines and documentation.
• Understand primary reporting workflows and participate in business/user meetings.
• Familiarity with reporting software used to support HMSA reporting needs.

Responsibilities

• Support MM by documenting system and business reporting requirements.
• Participate in system implementation projects under supervision.
• Develop tools to support Utilization Management activities.
• Coordinate activities with Information Management leadership and department.
• Provide system support and resolve inquiries from MM users.
• Organize training and manage access and equipment needs.
• Perform other duties as assigned.

Skills

Data reporting

Requirements gathering

Regulatory reporting

Analytics

Tools

Reporting software

Job description

1. Support Medical Management (MM)'s business solution requirements for the department through data reporting from various HMSA system applications and analytics utilizing established techniques or tools.
   
   • Solicit, document and/or clarify with business the reporting requirements and scope to include but not limited to what question is the business trying to answer, intent of the detailed data, anticipated audience, and summary requirements.
   • Maintain requisite knowledge of the current regulatory reporting requirements, including participation in relevant internal calls and/or meetings, researching and reading reporting guideline documentation.
   • Maintain requisite knowledge of current workflows for primary reporting requirements, including participation in meetings with the business and/or user groups.
   • Maintain requisite knowledge of reporting software / application used to support ALL reporting requirements through available documentation and/or attend trainings.
2. Participate in system implementation projects under the direction of the Senior Business Solutions Analyst, Business Solutions Administrator and/or Information Management Manager.
   
   • Solicit and document system and/or business requirements for a system solution to include but not limited to participation in calls, workgroups and/or meetings.
   • Develop and/or assist in the creation of various tools to support Utilization Management activities which may include system configuration, test case development and/or testing.
   • Provide feedback and/or elevate complex issues / concerns to appropriate lead.
3. Lead and/or coordinate specific activities that support department requirements under the direction of Information Management Manager, Director or Vice President of the department.
   
   
   • Manage the schedule, development, testing and implementation, as necessary, of the specific activity for the targeted audience(s).
   • Maintain requisite knowledge of the specific activity; including participation in relevant internal calls and/or meetings, researching and reading updated material/documentation.
4. Provide system support to all users on the various utilization management systems managed by Medical Management Department.
   
   
   • Resolve inquiries submitted directly to MM initiated through email, calls and walk-ins.
   • Assist Solutions Analyst with resolving more complex inquiries
   • Elevate unresolved complex inquiries.
   • Analyzes business problems and issues; coordinates input from various departments, units and/or staff to provide a recommendation or resolution to appropriate business owners.
5. Organize and conduct training on how to utilize solutions, includes systems and/or applications administered or developed by the MM.
   Coordinate and manage the security and equipment requirements for the department.
   
   
   • Completion, submission and tracking of access management requests.
   • Completion, submission and tracking of purchase requisitions for computer equipment.
6. Performs all other miscellaneous responsibilities and duties as assigned or directed.