Utilization Review Specialist - PACE

Description Schedule: Monday-Friday Day shift The Utilization Management Coordinator will work collaboratively with multiple disciplines, both internal and external to the organization to help provide high quality and cost-effective health management care for patients. Responsibilities include the review and tracking of ED admissions, inpatient hospitalizations, ICF and SNF utilization and specialist appointment utilization in the form of standardized reports which will be generated by the analyst to inform our clinical leadership and health plan regarding utilization trends and potential interventions. This coordination will allow one to work with our interdisciplinary PACE teams, the Inpatient Case Management Coordinator and Providence Health Plan bringing useful insight for ways we can reduce unnecessary resource utilization. Additional duties may include providing support around InterQual criteria for Inpatient Case Management Coordinators and Operations Managers. Development and updating key performance indicator reports for clinical and administrative staff. Assists the RN inpatient care management team to facility more efficient hospital discharges. Providence PACE is a Program of All-Inclusive Care for the Elderly that strives to keep older adults as healthy as possible living in the community through clinics, home visits and more. Join our team to help empower elders in your community to live active, independent lives. Required Qualifications Bachelor's Degree Experience with data collection and interpretation in the business or clinical setting, preferably within healthcare. Preferred Qualifications Master's Degree OR Data Analyst, Business background, or related fields with skills set complimentary to this position and a data analytics background. 1-2 years' work experience doing utilization review in either a hospital, ambulatory care, health plan setting, or an equivalent field within data sciences. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About The Team Providence Home and Community Care (HCC) is a service line within Providence with over 8,000 caregivers and 2,000 volunteers serving nearly 200,000 people a year, in their homes, in clinics and in a variety of congregate living ministries across our seven-state footprint. HCC provides a full range of services and support for people of all ages, especially those facing chronic or life-limiting illnesses. Our core competencies include restorative care, longitudinal care and care through the end of life. Our service lines include assisted living/skilled nursing/rehabilitation, home health, home infusion/pharmacy services, home medical equipment, hospice and palliative care, Program of All-Inclusive Care for the Elderly (PACE), personal home services/private duty care and supportive housing. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment 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. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Address: OR Portland 4400 NE Halsey St Work Location: Providence Health Plaza (HR) Bldg 1-Portland Workplace Type: On-site Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Full time Job Shift: Day Career Track: Business Professional Department: 5014 ADMINISTRATION OR REGION 1 Pay Range: $31.71 - $49.22 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. #J-18808-Ljbffr Providence