Utilization Review Analyst

Brief Description

Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. We operate Florida PACE (Program of All-Inclusive Care for the Elderly) Centers, the largest PACE program in Florida, which serves as a health plan, healthcare provider, and social center designed for older adults with complex medical needs. We have four adult day health centers that serve participants in Miami-Dade and Broward counties.

This Job Description also applies at Broward Pace Program sites.

The Utilization Review Analyst supports the Florida PACE Centers’ UM Program by combining administrative expertise with analytical skills to optimize healthcare resource use. This role ensures efficient workflows, compliance, and real-time oversight while collaborating with interdisciplinary teams and hospital partners. Responsibilities include managing documentation, coordinating communication, and analyzing utilization data to drive cost avoidance and improve participant-centered care.

• Coordinates and schedules UM‑related meetings and communications with interdisciplinary teams and hospital partners.
• Maintains accurate documentation of UM workflows, compliance reports, and participant records.
• Collects, tracks, and analyzes utilization data to identify trends and cost‑saving opportunities.
• Prepares dashboards and performance reports for leadership to support evidence‑based decision‑making.
• Monitors adherence to regulatory requirements and UM protocols to ensure compliance and participant‑centered care.
• Assists in audits and maintains readiness for compliance reviews.
• Supports real‑time oversight processes to reduce hospital length of stay and inpatient costs.
• Collaborates with clinical and finance teams to implement operational improvements and cost avoidance strategies.
• Manages communication and follow‑ups with hospital partners regarding observation pathways and short‑stay admissions.
• Ensures timely and accurate data entry into UM systems and maintains confidentiality of participant information.

• Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a related field.
• Master’s degree in Healthcare Management, Health Informatics, or a similar field preferred.

• 2–4 years of experience in healthcare administration, utilization management, or a related operational role.
• Hands‑on experience with utilization management processes, including real‑time oversight, observation pathways, and short‑stay admission workflows.

• Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), or Healthcare Compliance Certification (CHC) certifications preferred.
• Lean Six Sigma Green Belt certification preferred.

• Ability to interpret utilization data, identify trends, and support evidence‑based decision‑making.
• Ability to ensure high accuracy and completeness in all compliance records, reports, and data entry through exceptional attention to detail.
• Ability to manage multiple priorities, schedules, and workflows efficiently.
• Ability to address workflow challenges and contribute to process improvements.
• Ability to analyze utilization data, prepare performance reports, and support cost avoidance strategies.
• Ability to collaborate with interdisciplinary teams and hospital partners to optimize workflows and reduce inpatient costs.
• Ability to respond effectively to real‑time oversight needs and shifting priorities in a fast‑paced environment.
• Prior exposure to regulatory compliance and quality assurance in a healthcare setting.
• Demonstrates technical proficiency in using Excel and healthcare data systems to support reporting and analysis.

• Normal working condition with adequate lighting and ventilation.

• N/A.

• Ensures that resident’s/patient’s rights are adhered to.
• Demonstrates professionalism and accountability.
• Demonstrates a caring attitude consistent with Miami Jewish Empathicare® toward MJH residents, patients, family members, employees, and…