Utilization Specialist

Utilization Specialist

Kheir's mission is to increase and provide access to culturally and linguistically-sensitive quality primary healthcare and human services support to the underserved and uninsured residents of Southern California.

Assignment Summary

The Utilization Specialist at Kheir Clinic plays a critical role in ensuring that patients receive appropriate and effective healthcare services within our Federally Qualified Health Center (FQHC). This position involves assessing patient care needs, monitoring service utilization, and collaborating with healthcare providers to optimize patient outcomes while managing costs. The Utilization Specialist will work closely with the clinical teams, Director of Patient Services, and external stakeholders to support the delivery of high-quality care in alignment with the organization's mission and goals.

Minimum Qualifications

Two (2) years' schedule utilization experience in a clinical or managed care setting preferred.

Requires either a Bachelor's degree in Nursing or relevant Healthcare related field.

Basic computer skills in a Windows operating environment including Microsoft Word, Excel, and an e-mail system.

Must be a dynamic team member able to navigate a complex environment, with excellent verbal and written communication skills, as well as strong operations experience.

Effective influencing, negotiation, relationship-building and communication skills are essential.

Possess strong leadership, critical-thinking and motivational skills/abilities.

Excellent problem-solving and organizational skills required.

Knowledge of:

eClinicalWorks (eCW) electronic health records system.

FQHC outpatient clinics

NCQA, DMHC, CMS and other regulatory agency requirements pertaining to delivery of health care in the managed care setting.

Ability to:

Ability and willingness to travel among Kheir Clinic locations.

Demonstrate flexibility through change.

Lead and form part collaborative team.

Work effectively under pressure due to changing priorities.

Independently and self-direct activities.

Work effectively, establish, and promote positive relationships.

Adapt quickly to changing conditions while managing multiple priorities.

Essential Functions & Responsibilities

Collaborate with clinical staff and providers to ensure continuity of care and adherence to best practices.

Monitor patient capacity and utilization to ensure optimal scheduling for maximum patient visits.

Collaborate with the front office team to streamline scheduling processes and maximize capacity for patient appointments.

Maintain and track the daily minimum visit requirements for each service specialty, ensuring that all departments meet their targets.

Review scheduling reports and data analytics to assess current patient flow and identify potential bottlenecks or inefficiencies.

Develop and implement strategies to improve patient scheduling, maximize appointment availability, and minimize cancellations.

Analyze and adjust scheduling patterns to ensure the most efficient use of clinical resources.

Ensure that the scheduling system in eClinicalWorks is used effectively, making updates as necessary to reflect real-time capacity.

Provide regular reports and updates to leadership regarding patient utilization metrics, scheduling efficiency, and areas for improvement.

Act as a decision-maker when issues arise regarding patient visit scheduling, balancing the needs of patients with the capacity of the health center.

Address scheduling conflicts and communicate effectively with clinical and front-office teams to resolve issues promptly.

Maintain effective communication with service departments to ensure alignment with organizational goals and targets.

Generate reports on utilization capacity trends to inform management and stakeholders.

Participate in quality improvement initiatives to enhance patient care and resource optimization.

Identify process improvement opportunities and contribute to utilization management policies.

Ensure compliance with regulations related to utilization management and patient care.

Stay updated on changes in healthcare policies and best practices in utilization management.

Support a standardized Utilization Management Program that complies with various requirements.

Participate in data collection and analysis relevant to utilization management.

Collaborate with the Director of Patient Services to identify process improvement opportunities aligned with organizational goals.

Compile reports for statistical and financial tracking, identifying utilization trends and making recommendations.

Engage high-utilization across all sites to maximize schedule utilization and reduce no show trends

Perform additional duties as needed to meet business requirements.

Kheir Clinic provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Kheir Clinic complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Kheir Clinic will consider for employment all qualified Applicants, in a manner consistent with the requirements of applicable state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance.

Please note that this job description is subject to change to meet the needs of Kheir Clinic.