Utilization Analyst - San Jose

Overview:

Summary:

Develop and support relationships with contracted provider office staff that result in continued improvement in quality healthcare outcomes.

Responsibilities:

• Monitor network utilization trends and identify cost saving opportunities
• Identify members that require focus and are at risk of poor health outcomes
• Work with the clinical leadership to develop care plans for member cohorts
• Track utilization management and identify service area gaps for improvement
• Review treatment plans as assigned by the CMO to ensure necessity and appropriateness for the members
• Work with the CMO to prioritize assigned member cohorts to ensure timeliness standards
• Work with the CMO and Director of Contracting and Managed Care to consult with network providers on improving utilization of services
• Prepare and present analysis in a user friendly format
• Provide high level customer service

Qualifications:

QUALIFICATION REQUIREMENTS:

EDUCATION:

• High School Diploma or GED required; Associates Degree in Nursing, Bachelor of Science in Nursing degree or in a related field is preferred; equivalent work experience and education will be considered in lieu of a degree..

PRIOR EXPERIENCE:

• Two (2) or more years of experience in medical management, utilization management, case management or care coordination in an IPA or Health Plan setting preferred.

LICENSE/CERTIFICATION:

• Active Licensed Vocational Nurse (LVN) certification preferred
• Valid California Drivers license required

SKILLS:

• Strong verbal and written communication skills
• Must be able to establish rapport and effective working relationships with providers and health center administrators.
• Must have advanced proficiency in various computer applications and exemplary email communications skills.
• Must be able to prioritize multiple responsibilities and manage a large workload within budget and timelines.
• Must have excellent problem-solving skills and self-motivation.
• Must have the ability to develop alternative solutions to problems.
• Must be able to prepare clear, concise, thorough, meaningful, and grammatically correct written reports, letters, memos and other documents.
• Must be able to independently plan, organize, prioritize, schedule, coordinate, and make decisions related to assigned responsibilities.
• Must have a very strong customer service orientation, positive attitude, and be highly self-motivated, directed, and change oriented.
• Proficiency with the Microsoft Office, especially Microsoft Excel

The pay range for this Exempt position starts at $70,347.08 annually.

In addition, our comprehensive benefits package for regular status employees includes:

• Medical, Dental, and Vision insurance with low premium cost
• Paid time off and paid holidays
• 401k plan with matching contribution
• Educational Assistance
• Employee discounts and more!