Healthcare Utilization Analyst

1 week ago


Honolulu, Hawaii, United States HMSA Full time
Position Overview

The Healthcare Utilization Analyst plays a crucial role in optimizing medical review initiatives. This position involves the application of project management methodologies to effectively coordinate targeted medical review projects. The analyst will conduct thorough analyses to identify utilization patterns and trends, documenting findings and presenting actionable insights to management and relevant oversight committees.

Key Responsibilities
  1. Project Coordination: Employ project management techniques to oversee focused medical review initiatives, ensuring alignment with corporate objectives.
  2. Data Reporting: Collaborate with subject matter experts to develop comprehensive reports and dashboards that illustrate the impact of Utilization Management programs, highlighting direct cost savings and shifts in provider behavior.
  3. Issue Resolution: Proactively identify, investigate, and resolve issues, making informed decisions in accordance with established policies and procedures. Serve as a liaison between Medical Management and internal departments, fostering professional relationships with stakeholders.
  4. Documentation and Training: Create and maintain essential policy, procedure, and instructional documentation. Provide education and training to HMSA staff and providers on Medical Management activities and initiatives, encouraging input for the development of new programs.
  5. Collaboration: Actively support and participate in departmental and corporate workgroups and projects as assigned.
  6. Additional Duties: Perform all other miscellaneous responsibilities and tasks as directed.

This role is essential in driving quality outcomes and managing healthcare cost trends, contributing to the overall success of HMSA's initiatives.



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