Utilization Management Coordinator
About The Position
Our Utilization Review department manages both outpatient and inpatient patients. We work with Medicare, Medicare HMO, Medi-Cal, commercial insurance, including Medicare recertifications and other insurance authorization requirements. This role reviews clinical documentation, medical necessity, communicating with insurance companies, and ensuring patients meet the appropriate level-of-care criteria. The UR team works closely with providers, case management, and the clinical team to coordinate care, address insurance requirements, and support the best possible patient outcomes. This position requires strong clinical judgment, communication, organization, critical thinking, and time-management skills, as well as the ability to collaborate effectively with payers, providers, and the healthcare team. Make a difference by providing quality care alongside us at Ocean View!
Requirements
- High School Diploma or GED required
- ICD-10 Coding Knowledge or Certification
- Billing and Coding Knowledge or Certification
- Medical Records Knowledge or Certification
- 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 in behavioral health, healthcare, or hospital settings.
- Strong teamwork and collaboration skills across disciplines and departments.
- Proficiency in 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.
Nice To Haves
- Bachelors degree in health information management, healthcare administration, or related healthcare field.
- Bilingual English/Spanish +.
- Excellent verbal and written communication as well as strong interpersonal and organizational skills required.
- Previous JCAHO experience preferred.
- Prior experience using Electronic Health Records (EHR) systems for documentation and coordination of care.
Responsibilities
- Maintain accurate patient and payer records
- Submit 24-hour notification into LA County TAR Unit Database
- Complete and submit TAR forms accurately
- Print or upload patient medical records as required
- Track submissions to ensure Timely processing and Approval or denial status updates
- Monitor deadlines and ensure compliance with all timelines
- Manage denials by tracking appeal deadlines, preparing, and submitting appeal TARs
- Maintain tracking logs for all initial and appeal TARs
- While primarily assigned to the inpatient unit, may be required to support the Structured Outpatient Services Program (IOP/PHP) based on census fluctuations and departmental needs
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
