Adventist Health · 5 hours ago
Care Management Analyst Per Diem Temporary
Ukiah, CA
Full-time
Onsite
Mid Level
3+ years expAdventist Health is a faith-based, nonprofit integrated health system serving communities on the West Coast and Hawaii. The Care Management Analyst role involves reviewing patient encounters and medical records to identify improvement opportunities, supporting strategic initiatives, and collaborating with various departments to enhance the adjudication process.
Elder CareHealth CareHospitalMedicalNon ProfitWellness
No H1B
Responsibilities
Creates a regularly scheduled report set of key metrics (e.g., denials by category and market, overturned denial rate, write-off rate, etc.) related to the case management & revenue cycle team that is distributed to Adventist Health leadership. Uses data to investigate areas, such as clinical denials, to determine root-cause and subsequent mitigation action plans
Collaborates with necessary personnel or departments to implement action plans, using either verbal or written communication to emphasize importance of an issue. Prioritizes issues based on timeframe to implement, ease of implementation, and overall impact
Samples encounters that have received either a clinical or billing denial related to case management type denials (e.g., referral, pre-authorization, medical necessity, non-covered service, etc.) and validates the denial reason
Assists with developing and maintaining performance tools for ongoing reports and acts as a liaison to the utilization management committee. Identifies and escalates consistent issues/trends with payers to AH leadership
Keeps a pulse on any regulatory changes and payer policies that may affect Adventist Health. Maintains confidentiality of information in compliance with hospital policies and HIPAA
Performs other job-related duties as assigned
Qualification
Required
Associate's/Technical Degree in finance or business or equivalent combination of education/related experience
Preferred
Bachelor's Degree in mathematics, statistics, economics or finance or equivalent combination of education/experience
Three years' acute care hospital revenue cycle experience
Company
Adventist Health
Adventist Health is a Adventist Health is a not-for-profit health care organization .
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Gwen Mathews
CEO Ukiah Valley Medical Center, SrVP Operations AH Northern Cal Network
Kerry L. Heinrich
President and CEO
Recent News
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2025-12-11
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2025-11-13
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