Utilization Review Specialist

Your Work Here Matters. Your Career Here Thrives. Imagine coming to work every day knowing that what you do genuinely changes lives. At Henry Mayo Newhall Hospital , that's not just a tagline — it's the reality for every member of our team. We're not just a hospital. We're the heartbeat of the Santa Clarita Valley — a 357-bed, not-for-profit Level II Trauma Center that has been a trusted pillar of this community since 1975. And we're looking for passionate, driven professionals who want to be part of something bigger than themselves. Where Clinical Excellence Meets Cutting-Edge Care Here, you'll work alongside an award-winning team delivering some of the most advanced medical services in the region, including: Comprehensive heart and vascular care Advanced stroke treatment Cancer care in partnership with Keck Medicine of USC Women's imaging and breast health services Emergency and trauma care Cardiac rehabilitation and wellness programs As a key part of Los Angeles County's STEMI receiving network , we provide lifesaving cardiac intervention through our state-of-the-art Roberta G. Veloz Cardiac Cath Lab . We continuously invest in the latest technology and innovation — which means you'll always be working at the forefront of modern medicine. A Culture You'll Be Proud to Be Part Of Our vision — To Be the Most Patient-Centric Hospital Anywhere — drives everything we do. But it's our people who make that vision a reality. Physicians, nurses, staff, and volunteers come together here in a culture rooted in compassion, collaboration, and excellence . When you join Henry Mayo, you're not just accepting a job offer. You're joining a family that genuinely cares — about our patients, our community, and you . Located in Beautiful Valencia, California Nestled in the vibrant Santa Clarita Valley, you'll enjoy an exceptional quality of life both inside and outside of work — with top-rated schools, scenic surroundings, and a welcoming community that generations of families proudly call home. Ready to make your mark? Join the team that's been setting the standard for compassionate, innovative healthcare for nearly 50 years. Your next great chapter starts here. Job Summary: The Utilization Review (UR) Specialist ensures patients receive appropriate, cost-effective care by reviewing service utilization, coordinating treatment, and supporting discharge planning. Working closely with an interdisciplinary team, the UR Specialist monitors care delivery, facilitates communication with insurers and community resources, and ensures compliance with clinical and regulatory standards to optimize patient outcomes. Key responsibilities include conducting utilization reviews, interpreting regulatory guidelines, reviewing health records, and serving as a liaison among patients, families, healthcare providers, insurance companies, and community resources. The UR Specialist also refers complex psycho-social and discharge planning cases to clinical social workers, and provides education and support to staff on utilization practices. What You'll Bring to the Team: Develops, maintains, and models professional, objective and value-oriented interpersonal skills. Continuously promotes a patient-centered philosophy Maintains positive and proactive communication with patients, families, staff members, and physicians. Fosters team-building relationships. Excellent organizational skills and the ability to problem solve are essential Strong interpersonal skills, leadership, negotiation skills Knowledge of the payer industry, resource management, reimbursement, and evidencebased clinical practice is essential Licensure & Certification: Current CA license as a Licensed Clinical Social Worker (LCSW),Licensed Marriage and Family Therapist (LMFT), or Associate Clinical Social Worker (ASW). Current BLS provider card Education: Master’s degree in Social Work, Behavioral or Mental Health or a related health field preferred. Experience: Two years acute care experience Prefer one year post licensure work experience providing direct behavioral health care services Strong interpersonal skills, leadership, negotiation skills, good leadership talent, and Knowledge of hospital operations.Geneal knowledge of the payer industry, resource management, reimbursement, and evidence-based clinical practice is essential. #J-18808-Ljbffr