Utilization Analyst PT36 Nights
Job Summary
Essential Responsibilities
Captures and supervises data management, analyses, and reporting for KFH utilization management and Continuing Care Services, SCPMG, KFHP Outside Services management (e.g., day utilization at Outside facilities, and the Emergency Prospective Review Program and Air & Ground Transportation Program).
Uses computerized data management systems and manually maintained utilization data to implement and refine these systems.
Coordinates and supervises data and reporting needs, data collection process, and data processing issues, providing timely utilization data and analytic support.
Frequent contacts with other organizational units and outside facilities staff to obtain, verify, and/or provide information, such as working with Regional Claims and outside hospitals to reconcile billing charges.
Answers inquiries and educates 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 reinforces procedures for patients seen in outside emergency departments.
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.
Maintains 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
N/A
Licenses, Certifications, Registrations
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
This is a temporary position for approximately three (3) months. This is a variable position, days and hours may vary within the specified shift. If twelve (12) hour option chosen; shift will be 7:00 pm to 7:30 am. Back up 8-hour shift will be 7:00 pm to 3:30 am
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
Employee Status
Temporary
Employee Group/Union Affiliation
B01|SEIU|Local 399
Department
Independence Park - Emrgcy Pros Review Progm-EPRP - 0806
Pay Range
$31.18 - $33.42 / hour