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Utilization Review Coordinator

Prime Healthcare Management Inc
Ontario, CA
Utilization Review Coordinator Location Ontario, CA : Overview: Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. Know Your Rights: Responsibilities: Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings. Serves as on-going educator to all departments. Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. Performs other duties as assigned. Qualifications: Required qualifications: 1. Medical Graduate, Dental Graduate, PA, or Nursing Graduate required. Preferred qualifications: 1. ECFMG Certification And/or Bachelor's or higher from a US-based accredited institution in a Health and Human Services field is highly preferred. 2. Utilization Review experience is highly preferred. 3. Must meet the performance standards set forth by the Hospital/ Department at Medical Review Coordinator II position for at least 6 months. 4. 1+ year of clinical experience in acute care setting preferred. 5. Excellent written and verbal communication skills. Excellent critical thinking skills. 6. Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff. 7. Ability to work independently in a time-oriented environment. 8. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred. Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $30.00 to $40.50. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Posted 2025-11-09

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