Utilization Analyst

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. Experience Basic Qualifications: 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. KPHC - Medical records, Foundations / Mainframe experience. Notes If twelve (12) hour option chosen, shift will be 7:00 PM-7:30 AM, back up 8 hour shift will be 07:00PM -03:30 AMThis is a temporary position for approximately three (3) months. This is a part time position, days and hours may vary. Primary Location: California,Downey,Downey Boeing - Independence Park Scheduled Weekly Hours: 36 Shift: Variable Workdays: Sun, Mon, Tue, Wed, Thu, Fri, Sat Working Hours Start: 07:00 PM Working Hours End: 07:30 AM Job Schedule: Part-time Job Type: Standard Worker Location: Onsite Employee Status: Temporary Employee Group/Union Affiliation: B01|SEIU|Local 399 Job Level: Entry Level Department: Independence Park - Emrgcy Pros Review Progm-EPRP - 0806 Pay Range: $31.18 - $33.42 / hour Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location. Travel: No Work Setting: Onsite Worker location must align with Kaiser Permanente's Authorized States policy. 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.