Utilization Review Specialist - PACE

Description The Utilization Management Coordinator works collaboratively with multiple disciplines, both internal and external to the organization to provide high‑quality, cost‑effective health management care for patients. Responsibilities include reviewing and tracking ED admissions, inpatient hospitalizations, ICF and SNF utilization, and specialist appointment utilization. The analyst generates standardized reports to inform clinical leadership and health plans of utilization trends and potential interventions. Coordination with PACE teams, the Inpatient Case Management Coordinator, and Providence Health Plan helps identify ways to reduce unnecessary resource utilization. Additional duties may include supporting InterQual criteria for Inpatient Case Management Coordinators and Operations Managers, updating key performance indicator reports for clinical and administrative staff, and assisting the RN inpatient care management team to facilitate efficient hospital discharges. Qualifications Bachelor's Degree Experience with data collection and interpretation in business or clinical settings, preferably within healthcare. Preferred Qualifications Master's Degree or related data analyst/business background. 1–2 years of utilization review experience in a hospital, ambulatory care, health plan setting, or equivalent data science field. Schedule Monday‑Friday Day shift Employer Commitment Providence is an Equal Opportunity Employer. We value diversity and are dedicated to creating an inclusive workforce free from unlawful discrimination and harassment. Contact details and location information are provided in the job posting but are not part of the role description. #J-18808-Ljbffr Providence