Location
- On-Site in
- Long
- Beach,
- CA
- Schedule: 8-hour shifts
Pay Range
$26.00-28.00 hourly
Position Summary
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!
- Key Responsibilities
- Manage clerical processes related to Medi-Cal patients
- Extensive experience in insurance eligibility and benefits
- 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
- TAR Tracking & Compliance
- 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
Minimum Qualifications
- If not licensed, must have a Bachelors degree in social work or a related healthcare field
- ICD-10 Coding 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.
Preferred Qualifications
- 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.
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 immunizations in accordance with regulatory 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 work weekends based on operational or patient care needs
- Demonstrate understanding and be compliant with Patients' Rights, LPS Statutes, and Seclusion and Restraint Protocols.
