Healthcare Services Specialist / Job Req 570737031 (Finance)

PRINCIPAL RESPONSIBILITIES:
Under general guidance from the Senior Director, Health Care Services (HCS), the Director of Utilization Management (UM), and Director of Social Determinants of Health, (SDOH) the Healthcare Services Specialist is responsible for developing and running reports and assessing the quality of work completed by Health Care Services staff. The Healthcare Services Specialist will develop, prepare, analyze, and present UM, (Inpatient UM, Outpatient UM, Long Term Care UM), Case Management (CM), Enhanced Case Management (ECM), and Community Supports (CS) reports. The Healthcare Services Specialist will assist in departmental software optimization activities and policy writing. The Healthcare Services Specialist will also audit records to assist in training and reporting to meet the departments requirements.

Principal responsibilities include:
Develop, run (standard and ad hoc) reports, and analyze results in conjunction with HCS department leadership. Assist in reporting to Utilization Management (UM) Committee, Health Care Quality Committee, (HCQC), DMHC, DHCS, NCQA, JOMs, and Alliance Sub-Committees. Report quality findings to Directors of UM and SDOH and Senior Director, HCS. Collaborate with Analytics department to build reports for internal quality monitoring and/or in response to state and federal requirements. Assist in departmental software optimization activities to enhance reporting capabilities and process improvements. Have complete knowledge of the HCS applications/system and work with HCS and IT to identify areas of improvement and changes to the HCS applications as needed. Have knowledge of Operations software applications that interface with HCS software applications to participate in improvements designed to align and improve processes. Assist in developing, writing, and revising departmental policies and procedures. Assist in auditing of UM, CM, ECM, and CS staff performance to standard work to ensure operations comply with all regulations, standards, guidelines, policies, procedures, and workflows. Collect and analyze audit results to develop/maintain HCS training curriculum, developing training module content, learning objectives, and training/job aids. Collaborate with HCS leadership team to identify staff training and development needs for improved performance. Prepare and submit audit reports to HCS Leadership. Assist in the training and coaching of staff towards meeting and exceeding performance expectations for quantity, quality, timeliness, and efficiency.
Deliver training sessions to clinical and non-clinical staff on new policies, procedures, systems, requirements, and operational functions.
Support continuous improvement of operations between clinical and non-clinical staff through the development, evaluation and refinement of policies and procedures that meet the operational and regulatory goals and requirements. Participate in preparation for audits by DMHC, DHCS, NCQA, and Alliance Compliance department, including submitting departmental documents and case file preparation. Provide back up support to HCS staff when needed. Perform other duties and special projects as assigned.
ESSENTIAL FUNCTIONS OF THE JOB
Develop, run, and analyze reports, and communicate findings in an accurate and timely manner. Assist in the optimization of HCS software applications Process and procedure audits done in a timely manner and communicated to leadership. Assist with staff training. Collaborate with HCS staff and other departments to continuously improve operational performance. Participate in departmental and non-departmental meetings and other scenarios. Computer software and telephone usage. Comply with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
PHYSICAL REQUIREMENTS
Constant and close visual work at desk or on the computer. Frequent sitting and working at a desk. Frequent use of headset. Constant data entry using keyboard and/or mouse. Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person. Frequent lifting of folders, files, and other objects weighing between 0 and 30 lbs. Frequent walking and standing. Occasional need to stand for one to two hours at a time to deliver reports, training, or presentations to large groups.
Number of Employees Supervised: 0
MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:

Bachelors degree in health care, analytics, or other related field required.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

Two years of experience in developing, analyzing, and presenting reports on process outcomes required. Two years of experience auditing the performance of others and providing individual feedback preferred. Two years of experience in managed care setting; Medicare/Medi-Cal experience preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

Excellent oral, written communication, and presentation skills. Excellent analytical and database management skills.Leadership and team development skills. Ability to develop effective reports.Ability to represent organization and department well. Strong business acumen. Proficient in using computer software programs including all Microsoft Office suite products.
SALARY RANGE: $92,051.06-$138,076.59 ANNUALLY