Senior Utilization Review Analyst HealthHelp, Inc.
THIS JOB HAS EXPIRED Job Description
Essential Duties and Responsibilities:
Daily monitoring of utilization reports, outliers, and unexpected patterns.
Determine causes of under or over-utilization of healthcare services under each of the clinical programs.
Ownership of Savings & Safety Opportunity Reporting with retrospective utilization review to determine the means to recoup lost savings and improve safety.
Managing the HealthHelp quality improvement program
Determining providers with over and under-utilization patterns and recommending them for disciplinary action.
Providing Daily Reporting to Client Services for each client, along with interpretation and observations for utilization trends seen from the reports.
Help R&D team determine benchmarks based on state, regional, demographic and other factors that effect utilization of healthcare services.
Create and provide alert reports to Clinical team and Client Services to take specific actions with providers, medical directors, or Client?s markets.
Produce reports and other tools to help with execution of initiatives, track results and provide feedback
Works with leadership to identify, define and utilize standard tools and analytical approaches
Bachelor?s degree in Business, Finance, Healthcare, Informatics or related field required.
Minimum of 7 years of relevant work experience with a minimum of 5 years experience in healthcare, preferably in a managed care environment and more specifically in Utilization Management review.
Health industry knowledge, especially managed care, strongly preferred
Experience analyzing various healthcare data and providing medical cost analysis
Highly Proficient in Microsoft Excel; working knowledge of SQL or MS Access
Demonstrated knowledge of statistical analysis and statistical concepts
Strong problem-solving/analytical and organizational skills
Excellent communication and presentation skills, both verbal and written essential
Proven ability to work well under time constraints with resiliency to change priorities as business needs dictate
Work Environment: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk and hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms.
As business need dictates but estimated to be less than 20%.
Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
HealthHelp provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws.
Houston, Texas, United States
||Houston, TX |
THIS JOB HAS EXPIRED