Utilization Review Specialist - PACE

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.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.