Utilization Review Coordinator

Location: On-Site inLong Beach, CA Schedule: 8-hour shiftsThursday-Monday Pay Range: $26.00-28.00 hourly PositionSummary The Utilization Review (UR) Coordinator provides administrative support to ensure compliance with HMO, Medicare, and Medi-Cal insurance requirements throughout patient hospitalizations. Key responsibilities include auditing charts, analyzing resourceutilizationpatterns, reporting trends to the Utilization Review Committee, and implementing systems to improve care efficiency. Make a difference by providing quality care alongside us at Ocean View! Key Responsibilities Manage clerical processes related to Medi-Cal patients Extensive experience in insurance eligibility and benefits Maintainaccuratepatient and payer records Submit24-hour notificationinto LA County TAR Unit Database Complete andsubmitTAR forms accurately Print or upload patient medical records asrequired Track TAR submissions to ensureTimely processingandApproval or denial status updates TAR Tracking & Compliance Verify TAR details in Medi-Cal system Monitor deadlines and ensure compliance with all timelines Manage denied TARs bytracking appeal deadlines,Preparing,andsubmittingappeal TARs Maintain tracking logs for allinitialand appeal TARs While primarily assigned to the inpatient unit, may berequiredto support the Structured Outpatient Services Program (IOP/PHP) based on census fluctuations and departmental needs While primarily assigned to the Structured Outpatient Services Program (IOP/PHP), may berequiredto support the inpatient unit based on census fluctuations and departmental needs Minimum Qualifications If not licensed, must have aBachelorsdegree in social work or a relatedhealthcare field Ability to interact and communicate verbally and in writing with seriously and persistently mentally ill Patients, other staff members, and the public. Ability to speak, read, and write legibly in English. Minimum of two (2) years of experience inbehavioralhealth, healthcare, orhospitalsettings. Strong teamwork and collaboration skills across disciplines and departments. Proficiencyin the use of computers and standard keyboard functions for data entry and electronic documentation. Experience using Electronic Health Records (EHR) systems for documentation and coordination of care. Preferred Qualifications AAdegree with a California RN, LVN, or LPT license. Bilingual English/Spanish+. Excellent verbal and written communication as well as strong interpersonal and organizational skillsrequired. Medical Records certificationpreferred. PreviousJCAHO experience preferred. Prior experience using Electronic Health Records (EHR) systems for documentation and coordination of care. Benefits Comprehensive medical, dental, and vision insurance for qualifying employees 401(k) retirement savings plan Supportive, team-oriented work environment Opportunities for professional growth, training, and advancement within the organization Special Conditions Employment is contingent upon successful completion of Live Scan fingerprinting, background check clearance, and verification of required licenses, certifications, and education Satisfactory completion of professional reference checks Must be legally authorized to work in the United States; Ocean View does not provide visa sponsorship for certain roles unless otherwise specified Compliance with all applicable federal, state, and local regulations, including California Department of Health Care Services (DHCS), The Joint Commission, and HIPAA standards Compliance with all required health screenings and immunizationsin accordance withregulatory guidelines and facility policy, which may include tuberculosis (TB) testing, N95 fit testing, annual trainings, and proof of vaccination for certain communicable diseases Availability to workweekends based on operational or patient care needs Demonstrate understandingand becompliant with Patients’ Rights, LPS Statutes, and Seclusion and Restraint Protocols. #J-18808-Ljbffr