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Company: Presbyterian Healthcare Services
Location: Albuquerque
Posted on: November 22, 2021

Job Description:

Overview:*This position is remote eligible to candidates located in the United States with the exclusion of the states: Washington, Ohio, Wyoming, and North Dakota.*Job DescriptionType of Opportunity: Full TimeFTE: 1.000000Exempt: YesWork Schedule: DaysSummary:The Utilization Management Data & Reporting Specialist is responsible for the day-to-day management of data that supports Utilization Management operations. This includes leading reports development, performing testing, quality review, complex analysis and interpretation, and delivering verbal and written presentations of data and results to internal and external stakeholders. This role is also responsible for supporting departmental auditing and monitoring through the development of internal monitoring reports and tools, the testing and quality review of audit universes, and final delivery of regulatory reporting and audit universe deliverables. The Utilization Management Data & Reporting Specialist serves as a subject matter expert for utilization management data.Responsibilities:Responsibilities:

  • Leads reports development, partnering with UM operations, AO, and IT to submit, develop, test, and deliver reports.
  • Performs complex data analysis of utilization management data and performance to provide essential information to UM leadership to support and facilitate operations.
  • Enhances auditing and monitoring process through the development of data automation for the UM Quality Assurance team.
  • Responsible for regulatory reporting including monitoring for new reports and changes to existing reports; implementing new reports and report changes; compiling all data and analysis for regulatory required reporting, including reviewing data for accuracy, resolving inaccurate data, providing feedback to operations to develop analysis, compiling final reports, and delivering reports in accordance with report specifications.
  • Responsible for operations reports including defining report requirements, leading implementation in collaboration with key stakeholders, testing, and delivering reports.
  • Responsible for internal and external audit universes, including monitoring for new and changing specifications, implementing specifications, compiling the universe, reviewing for data accuracy, resolving data issues, preparing final universes, and delivering universes in accordance with audit specifications.
  • Develops and delivers presentations and communications related to utilization management data, both verbal and written, with internal and external stakeholders.
  • Performs other duties as assigned.Qualifications:Other information:Education: Bachelors Degree required.Bachelors degree in a related field required; Masters degree preferred. Minimum of 7 years of experience developing, analyzing, interpreting and presenting data to various organization levels (entry level to senior leadership) required. Five or more years of health care experience working with cross functional team(s) required. Three or more years of managed care experience required with strong knowledge of Utilization Management operations. Proficiency in Excel as well as data analysis and interpretation required. Proficiency in other data/reporting tools highly preferred. Experience leading complex projects with diverse teams and developing outcomes-based initiatives to improve business and operational efficiencies required. Strong interpersonal, verbal and written communication skills are required.Education:Essential:
    • Bachelor DegreeBenefits:BenefitsBenefits are effective day-one (for .45 FTE and above) and include:
      • Competitive salaries
      • Full medical, dental and vision insurance
      • Flexible spending accounts (FSAs)
      • Free wellness programs
      • Paid time off (PTO)
      • Retirement plans, including matching employer contributions
      • Continuing education and career development opportunities
      • Life insurance and short/long term disability programsAbout UsPresbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans.We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.About New MexicoNew Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great.Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC.New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.#ITA123

Keywords: Presbyterian Healthcare Services, Albuquerque , UTILIZATION/ MANAGEMENT DATA AND REPORTING SPECIALIST - REMOTE ELIGIBLE, Executive , Albuquerque, New Mexico

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