Providence Health & Services Utilization Management Analyst in Mission Hills, California

Description:

Providence is calling a Utilization Management Analyst ( Full Time / Day Shift ) to our Facey Utilization Management location in Mission Hills, CA.

In this position you will:

  • The primary responsibility of the position is to maintain standard compliance and performance related utilization management data.

  • Process of daily, weekly and monthly UM reports.

  • Establish and maintains efficient filing system in paper and electronic.

  • Assist with preparation of quarterly macro presentation and weekly UM committee.

  • Maintain Health Plan audit tools including distribution and collection of data and documentation.

  • Maintain all UM referral tools and all training materials for UM RS and RN Case Managers in all UM shared folders.

  • Assist in data collection for all Health Plan audits.

  • Maintain minutes for all UM meetings in accordance with compliance regulations set forth by NCQA.

  • Perform other duties as assigned by Utilization case managers, Contract manager and UM supervisors, under the supervision of Administrative Director of Managed Care.

  • The position requires strong analytical and utilization modeling skills.

  • The position requires strong interpersonal, professional communication skills.

  • Answer and screen phones.

  • Schedule and coordinate all meetings attended by Administrative Director of Managed Care, Contract Manager, Case Managers and UM supervisors.

  • Provide vacation coverage for Executive Administrative Assistant duties as assigned.

Qualifications:

Required qualifications for this position include:

  • Associate's degree, Bachelor's degree or equivalent work experience, preferably in the healthcare, business or related field.

  • Knowledge of managed health care marketplace, health delivery systems, contract basics.

  • Strong quantitative and analytical skills and ability to meet critical deadlines.

  • Ability to compose letters, correspondence and create reports from data bases.

  • Knowledge of CMS, NCQA, DMHC, ADA and HIPAA regulations.

  • Ability to handle multiple tasks including project management and quantitative analysis.

  • Extensive knowledge of personal computer and peripheral equipment with database software.

  • Familiarity with assorted office equipment (i.e. fax photocopier, telephone and keyboard).

  • Excellent office and administrative skills.

  • Proficient in MS Office:Word, Excel, Power Point, Access, SQL reports and Crystal Reports.

  • Excellent customer service skills.

  • Must have initiative and use proper judgment with minimal supervision.

  • Must be detail oriented, organized, ability to prioritize and manage multiple projects with clearly stated timeliness.

About the organization you will serve:

Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita and Simi Valleys. The group began as a single medical practice over 90 years ago.

Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.

We offer a full comprehensive range of benefits - see our website for details

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Administrative Support (Clinical)

Location: California-Mission Hills

Req ID: 186985