Utilization Analyst-UHW

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.

• 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.

• N/A

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

• N/A

• 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.

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

• Preferred: KPHC - Medical Records, Foundations / Mainframe Experience.

Notes:

• This is a temporary position for approximately three (3) months.
• This is a variable position, start times may vary within the specific shift.
• Shifts Vary (DAY: 07-1930, EVE: 1300-0130, Night: 1900-0730)

PrimaryLocation : California,Downey,Downey Boeing - Independence Park
HoursPerWeek : 36
Shift : Variable
Workdays : Sun, Mon, Tue, Wed, Thu, Fri, Sat
WorkingHoursStart : 07:00 PM
WorkingHoursEnd : 07:30 AM
Job Schedule : Part-time
Job Type : Standard
Employee Status : Temporary
Employee Group/Union Affiliation : B01|SEIU|Local 399
Job Level : Entry Level
Job Category : QA, UR & Case Management
Department : Independence Park - Emrgcy Pros Review Progm-EPRP - 0806
Travel : No
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.

• Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.

• Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.