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Utilization Management Analyst

Mercy Healthcare Santa Cruz, California
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The posted compensation range of $36.00 - $51.08 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.

Requisition ID 2026-459952 Employment Type Full Time Department Utilization Review Hours/Pay Period 80 Shift Day Weekly Schedule 8am-5pm Monday-Friday Remote Yes Category Medical Coding

Job Summary and Responsibilities

The incumbent in this position supports the design, implementation and maintenance of clinical quality and outcome analytical systems for the Utilization Management Hub. This position provides technical support, statistical analysis and report generation. This position will focus on the retrieval of financial and clinical information at the patient level, including summarization of results to identify underlying trends. This position requires an expert understanding of medical record data, risk/severity adjustment systems and clinical as well as population based research methodologies. The incumbent will be required to collaborate with the System Care Coordination Leadership, Hospital Care Coordination Leadership, Utilization Management Hub Leadership, Quality Management and various other departments in the production of indicators and reports which incorporate measures of utilization management, clinical denials and department productivity.

  • Ensure that all actions taken and methods used to produce the results outlined above incorporate and promote the Mission and Philosophy of CommonSpirit Health. The incumbent will be responsible for supporting the structures and processes necessary for providing clinically based health care information and analytic resources for clinical quality and performance improvement.
  • Provide comprehensive planning assignment implementation, management and evaluation of assigned projects to meet the goals and objectives of Utilization Management and other departments as appropriate.
  • Prepare written reports and make oral presentations as requested.
  • Demonstrate initiative and personal accountability for actions using judgment and insight to solve problems and find better or more efficient ways to do things.
  • Holds self and other accountable for ethical behaviors.
  • Adapts to change, recognizes and appreciates the value of differing perspectives, develops innovative ideas and solutions, modifies plans and objectives given changing priorities or environment.

Job Requirements

Minimum:

  • Bachelor's Degree or equivalent combination of applicable experience and education may be accepted at the hiring manager's discretion

  • A minimum of three years analytical experience using analytical tools, computers, and databases supporting the Case Management department

  • Strong database management experience

  • Relevant healthcare experience
  • Strong critical thinking skills to problem solve and develop/implement solutions
  • Proficiency with establishing and maintaining relational databases

  • Proficiency with personal computer operations and software (i.e. Google docs, Google sheets, Google slides, Word, Excel, PowerPoint) May include the use of Access, StrataJazz, MS4, Artiva and Midas

  • Effective verbal and written communication including correct English usage (spelling, grammar and punctuation) to effectively communicate with individuals at all levels and from all backgrounds
  • Good cognitive and interpersonal skills
  • Fluency in use of database and multiple automation tools
  • Perform basic arithmetic and statistical calculations
  • Computer skills including data entry, retrieval and analysis
  • Chart analysis, abstracting chart information
  • Knowledge of regulations pertaining to confidentiality and the release of patient information along with TJC standards, DHS regulations, hospital requirements as they pertain to medical records

Preferred:

  • Clinical experience with quality assurance/improvement

  • Experience in utilization management, case management, and or managed care

Where You'll Work

Dignity Health, one of the nation’s largest health care systems, is a 22-state network of more than 9,000 physicians, 63,000 employees, and 400 care centers, including hospitals, urgent and occupational care, imaging and surgery centers, home health, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high-quality, and affordable patient-centered care with special attention to the poor and underserved..  

One Community. One Mission. One California

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Equal Opportunity

CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.