We are recruiting for a Data Analyst to join our team in Fresno, CA. This position is fully in-person and reports to our office in Fresno full-time. 

The Data Analyst collaborates with Chief Medical Officer (CMO) and Contracting and Managed Care Officer (CMCO) to track medical management, quality management, and patient and provider grievances, and assist in delivering superior customer service. Works with the CMCO and CMO to implement and manage effective utilization management processes that result in lower costs, efficient utilization of services and optimize clinical outcomes. Collaborate with clinical team members to evaluate the potential over and/or underutilization of specialty services based on clinical protocols. Develop and support relationships with contracted provider office staff that result in continued improvement in quality healthcare outcomes.

Performance Area # 1 - Utilization Data Analytics  

• Extract, transfer and download data from various sources
• Perform exploratory data analysis to uncover trends, patterns, and anomalies
• Monitor network utilization trends and identify cost saving opportunities
• Identify members that require focus and are at risk of poor health outcomes
• Work with the clinical leadership to develop care plans for member cohorts
• Track utilization management and identify service area gaps for improvement
• Review treatment plans as assigned by the CMO to ensure necessity and appropriateness for the members
• Work with the CMCO to prioritize assigned member cohorts to ensure timeliness standards
• Work with the CMO and CMCO to consult with network providers on improving utilization of services
• Prepare and present analysis in a user friendly format on a regular basis
• Create visually appealing and interactive dashboards, reports, and presentations
• Communicate findings and recommendations to stakeholders using data visualization tools
• Collaborate with cross-functional teams to design and deliver actionable insights

Performance Area #2: Audits and Data Quality Assurance

• Validate data accuracy, completeness, and integrity
• Identify and address data quality issues and discrepancies
• Implement data quality controls, audits, and monitoring mechanisms
• Serve as internal UPN provider advocate by communicating key provider pain points and work with key stakeholders to advance support of UPN’s contracted providers
• Collaborate with Marketing, Sales, Provider Data, Credentialing, Operations, and other teams to coordinate cross-functional in-market activities
• Adheres to the Policies and Procedures set forth by the Quality Management Committee
• Build provider awareness and engagement with UPN
• Other responsibilities as assigned.
• Build provider awareness and engagement with UPN

EDUCATION:

• High School Diploma or GED required.
• Bachelor of Science in Health Administration, Finance or related field is preferred; equivalent work experience and education will be considered in lieu of a degree.

PRIOR EXPERIENCE:

• Two (2) or more years of experience in data management, medical management, utilization management, or case management in an IPA or Health Plan setting preferred.

SKILLS:

• Strong verbal and written communication skills.
• Proficiency with the Microsoft Office, especially Microsoft Excel
• Must be able to establish rapport and effective working relationships with providers and health center administrators.
• Must have advanced proficiency in various computer applications and exemplary email communications skills.
• Must be able to prioritize multiple responsibilities and manage a large workload within budget and timelines.
• Must have excellent problem-solving skills and self-motivation.
• Must have the ability to develop alternative solutions to problems.
• Must be able to prepare clear, concise, thorough, meaningful, and grammatically correct written reports, letters, memos and other documents.
• Must be able to independently plan, organize, prioritize, schedule, coordinate, and make decisions related to assigned responsibilities.
• Must have a very strong customer service orientation, positive attitude, and be highly self-motivated, directed, and change oriented.

The pay range for this Exempt position starts at $70,347.08 annually. Our salaries are dependent on knowledge, skills, and experience.

In addition, our comprehensive benefits package for regular status employees includes:

• Medical, Dental, and Vision insurance with low premium cost
• Paid time off and paid holidays
• 401k plan with matching contribution
• Educational Assistance
• Employee discounts and more!