Utilization Review Coordinator

Ocean view psychiatric hospital • Long Beach, CA

2d • $26 - $28 • Onsite

About The Position

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 resource utilization patterns, 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!

Requirements

• If not licensed, must have a Bachelors degree in social work or a related healthcare 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 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

• AA degree with a California RN, LVN, or LPT license.
• Bilingual English/Spanish +.
• Excellent verbal and written communication as well as strong interpersonal and organizational skills required.
• Medical Records certification preferred.
• Previous JCAHO experience preferred.
• Prior experience using Electronic Health Records (EHR) systems for documentation and coordination of care.

Responsibilities

• Manage clerical processes related to Medi-Cal patients
• 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 TAR submissions to ensure Timely processing and Approval or denial status updates
• Verify TAR details in Medi-Cal system
• Monitor deadlines and ensure compliance with all timelines
• Manage denied TARs 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
• While primarily assigned to the Structured Outpatient Services Program (IOP/PHP), may be required to support the inpatient unit 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level