ZipRecruiter

Log In

1

Utilization Analyst Jobs in California (NOW HIRING)

previous page

Showing results 41-60

All JobsUtilization Analyst JobsUtilization Analyst Jobs in California

Utilization Analyst information

What is the difference between Utilization Analyst vs Data Analyst?

AspectUtilization AnalystData Analyst
Required CredentialsBachelor's in healthcare, business, or related field; certifications like CPC or HCISPPBachelor's in statistics, computer science, or related field; certifications like CAP or Microsoft Certified Data Analyst
Work EnvironmentHealthcare facilities, insurance companies, or healthcare consulting firmsVarious industries including finance, marketing, healthcare, and technology
Employer & Industry UsageUsed primarily in healthcare and insurance sectors to optimize resource utilizationUsed across multiple industries to analyze data trends and support decision-making

While both roles involve analyzing data, a Utilization Analyst focuses on healthcare resource management and efficiency, whereas a Data Analyst has a broader scope across industries, analyzing diverse data sets to inform strategic decisions.

What does a utilization analyst do?

A utilization analyst monitors and analyzes the use of resources, such as staff or equipment, to ensure efficiency and cost-effectiveness. They often work with data management tools and generate reports to identify areas for improvement in resource allocation and productivity.
What are popular job titles related to Utilization Analyst jobs in California? For Utilization Analyst jobs in California, the most frequently searched job titles are:
What job categories do people searching Utilization Analyst jobs in California look for? The top searched job categories for Utilization Analyst jobs in California are:
What cities in California are hiring for Utilization Analyst jobs? Cities in California with the most Utilization Analyst job openings:
Utilization Analyst jobs near you
Infographic showing various Utilization Analyst job openings in California as of August 2026, with employment types broken down into 87% Full Time, 4% Part Time, 2% Temporary, and 7% Contract. Highlights an 96% In-person, and 4% Remote job distribution.

UTILIZATION MANAGEMENT COORDINATOR II MSO

NORTH EAST MEDICAL SERVICES

Burlingame, CA

$39.69 - $45.10/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 5 days ago

Job description

The Utilization Management Coordinator II functions under the direct supervision of a physician or Registered Nurse performing utilization management (UM) and care coordination duties for the NEMS MSO. The UM Coordinator II will also provide basic training to the junior UM Coordinators.

ESSENTIAL JOB FUNCTIONS:

  • Responsible to review Referral Requests and Treatment Authorization Requests received daily; process and approve authorization requests according to the NEMS MSO Authorization Grid and established clinical guidelines.
  • Provide guidance to junior UM Coordinators during research of additional clinical guidelines from different sources for complex cases.
  • Responsible to lead the junior UM Coordinators to prepare and present complex cases to Medical Director for review and ensure follow up activities.
  • Responsible for reviewing the confirmed MD approval/modification/denial decision and notes for record tracking purposes.
  • Responsible to prepare UM Notice of Action (NOA) to provider and member for UM denial decision per AB1455 turn-around-time requirement.
  • Responsible for preparing UM statistical reports and submit to health plans per contract requirement.
  • Perform Care Coordination activities with members, families, specialists, and ancillary providers for authorized services.
  • Perform case investigation for member and/or provider complaints and appeals related to UM denials, and report findings to Health Plan.
  • Provide transition of care services to members who are discharged from the hospital.
  • Perform customer services for UM inquires to PCP, specialist, and members.
  • Stay current with DHCS regulations, Health Plan agreements, and Industry Standard guidelines applicable to healthcare programs.
  • Communicate with Health Plan for clarification about clinical guidelines for covered/uncovered benefits.
  • Communicate UM related information and updates to all members of the health care team, patients, and their families.
  • Follows the appropriate turnaround timeframe for decisions and notification of members and providers.
  • Performs other job duties as required by manager/supervisor.
     
  • BS/BA Degree in Health Science or General Education highly preferred.
  • Minimum of one year of experience in utilization management required.
  • Recent experience in a clinic or outpatient setting desirable; able to perform efficiently and appropriately in a busy environment.
  • Current Medical Assistant Certification or California Pharmacy Technician License or equivalent experience in a health care field is a plus.
  • Knowledge of medical terminology is a must
  • Strong communication, analytical, and problem-solving skills.
  • Knowledge of community resources and cultural needs.
  • Good organization and prioritization skills, outstanding in time management.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluent in Chinese (Cantonese and/or Mandarin) preferred.
  • Fluent in other languages is an asset.

STATUS:

  • This is an FLSA Non-exempt position.
  • This is not an OSHA high-risk position.
  • This is a full-time position. 

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
 

Apply