Prospect Medical Holdings, Inc.
Utilization Review Specialist - Full Time, Days (Hollywood)
Prospect Medical Holdings, Inc., San Jose, California, United States, 95199
Utilization Review Specialist - Full Time, Days (Hollywood)
Utilization Review Specialist - Full Time, Days (Hollywood)
4 weeks ago Be among the first 25 applicants Prospect Medical Holdings, Inc. provided pay range
This range is provided by Prospect Medical Holdings, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$23.20/yr - $30.10/yr Job Description
Under the direction of the Director/Manager of Case Management, the Utilization Review Specialist directs all back-office functions of the Case Management Department. Interfaces with all payors/providers requesting authorizations, medical records, and other specific information. Confirms completeness of reviews to payors. Redirects denials to centralized department. Assists the Lead Case Manager with coordinating schedules and assignments of Case Management Team. Provides clerical functions to the Case Management Department, ensuring smooth office operations.
Responsibilities
Interfaces with all payors and providers requesting authorizations, medical records, and other specific information. Completes payor and provider request for missing or additional documentation. Logs all authorization requests to ensure that they are submitted the same day as requested. Forwards all managed care/payor questions, correspondences and authorizations to Director/Manager of Case Management (or designee). Ensures that all requests are handled appropriately and in a timely manner. Performs basic reception functions to ensure smooth office operations, including answering incoming calls, maintaining an accurate filing system, ensuring office supplies stocked to appropriate levels and office equipment serviced, copying forms and documents, etc. Types memos and other case management documents as assigned. Effectively uses computer programs. Accurately collects and documents all necessary and required information and activities into the appropriate computer systems. Clears all providers, such as home health, LTACH, SNF, board and care, prior to providing patient access. Directs providers where they need to go and ensures they get there in a timely manner. Ensures that all patient privacy guidelines/laws are followed. Maintains audits for timely completion of Utilization Reviews. Completes audits for retroactive reviews and provides same day summary to Director of Case Management. Ensures that all reviews are completed and received by the payor in a timely manner. Maintains status and oversees required performance improvement data/documents for current PI/Quality indicators. Cross references multiple sources of data, ensuring that information is in appropriate place in patient medical records. Accurately collects data and organizes graphs, PowerPoints, or needed presentation materials under the direction of the Leader of the Department and/or UR Committee members. Completes all assigned Performance Improvement tasks in a timely and accurate manner. Accurately collects data and organizes graphs, PowerPoints, or needed presentation materials under the direction of the Leader of the Department and/or UR Committee members.
Qualifications
Southern Cali Hospital Hollywood
Required Qualifications:
Knowledge of utilization management 2 years works experience Must demonstrate customer service skills appropriate to the job Computer literacy and proficiency Excellent written and verbal communication skills Ability to establish and maintain effective working relationships within the organization Ability to multitask and maintain a work pace appropriate to workload
Pay Rate: Min - $23.20 | Max - $30.10
About Us
Southern California Hospital at Hollywood is a 100-bed acute care facility and 24/7 urgent care with a mission and vision to provide compassionate healthcare accessible to everyone. Southern California Hospital at Hollywood provides comprehensive, high-quality medical care. As an acute care facility, we have physicians and specialists on staff for the following: cardiology, pulmonology, internal medicine, psychiatry, orthopedics, hematology, endocrinology, podiatry, cardiothoracic vascular surgery, urology, plastic surgery, and more. Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Other Industries Hospitals and Health Care, Medical Practices, and Mental Health Care Referrals increase your chances of interviewing at Prospect Medical Holdings, Inc. by 2x Sign in to set job alerts for “Specialist” roles.
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Utilization Review Specialist - Full Time, Days (Hollywood)
4 weeks ago Be among the first 25 applicants Prospect Medical Holdings, Inc. provided pay range
This range is provided by Prospect Medical Holdings, Inc.. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range
$23.20/yr - $30.10/yr Job Description
Under the direction of the Director/Manager of Case Management, the Utilization Review Specialist directs all back-office functions of the Case Management Department. Interfaces with all payors/providers requesting authorizations, medical records, and other specific information. Confirms completeness of reviews to payors. Redirects denials to centralized department. Assists the Lead Case Manager with coordinating schedules and assignments of Case Management Team. Provides clerical functions to the Case Management Department, ensuring smooth office operations.
Responsibilities
Interfaces with all payors and providers requesting authorizations, medical records, and other specific information. Completes payor and provider request for missing or additional documentation. Logs all authorization requests to ensure that they are submitted the same day as requested. Forwards all managed care/payor questions, correspondences and authorizations to Director/Manager of Case Management (or designee). Ensures that all requests are handled appropriately and in a timely manner. Performs basic reception functions to ensure smooth office operations, including answering incoming calls, maintaining an accurate filing system, ensuring office supplies stocked to appropriate levels and office equipment serviced, copying forms and documents, etc. Types memos and other case management documents as assigned. Effectively uses computer programs. Accurately collects and documents all necessary and required information and activities into the appropriate computer systems. Clears all providers, such as home health, LTACH, SNF, board and care, prior to providing patient access. Directs providers where they need to go and ensures they get there in a timely manner. Ensures that all patient privacy guidelines/laws are followed. Maintains audits for timely completion of Utilization Reviews. Completes audits for retroactive reviews and provides same day summary to Director of Case Management. Ensures that all reviews are completed and received by the payor in a timely manner. Maintains status and oversees required performance improvement data/documents for current PI/Quality indicators. Cross references multiple sources of data, ensuring that information is in appropriate place in patient medical records. Accurately collects data and organizes graphs, PowerPoints, or needed presentation materials under the direction of the Leader of the Department and/or UR Committee members. Completes all assigned Performance Improvement tasks in a timely and accurate manner. Accurately collects data and organizes graphs, PowerPoints, or needed presentation materials under the direction of the Leader of the Department and/or UR Committee members.
Qualifications
Southern Cali Hospital Hollywood
Required Qualifications:
Knowledge of utilization management 2 years works experience Must demonstrate customer service skills appropriate to the job Computer literacy and proficiency Excellent written and verbal communication skills Ability to establish and maintain effective working relationships within the organization Ability to multitask and maintain a work pace appropriate to workload
Pay Rate: Min - $23.20 | Max - $30.10
About Us
Southern California Hospital at Hollywood is a 100-bed acute care facility and 24/7 urgent care with a mission and vision to provide compassionate healthcare accessible to everyone. Southern California Hospital at Hollywood provides comprehensive, high-quality medical care. As an acute care facility, we have physicians and specialists on staff for the following: cardiology, pulmonology, internal medicine, psychiatry, orthopedics, hematology, endocrinology, podiatry, cardiothoracic vascular surgery, urology, plastic surgery, and more. Seniority level
Seniority level Entry level Employment type
Employment type Full-time Job function
Job function Other Industries Hospitals and Health Care, Medical Practices, and Mental Health Care Referrals increase your chances of interviewing at Prospect Medical Holdings, Inc. by 2x Sign in to set job alerts for “Specialist” roles.
Fremont, CA $95,000.00-$143,000.00 3 weeks ago Executive Assistant to VPs of Product Management
San Jose, CA $101,000.00-$112,000.00 1 week ago San Jose, CA $128,000.00-$240,667.00 2 weeks ago Sunnyvale, CA $114,000.00-$163,000.00 5 days ago San Jose, CA $60,000.00-$65,000.00 2 years ago Payment Customer Support Specialist - USDS
San Jose, CA $88,000.00-$151,112.00 6 days ago San Jose, CA $88,000.00-$151,112.00 2 weeks ago Morgan Hill, CA $50,000.00-$60,000.00 20 hours ago Palo Alto, CA $50,000.00-$60,000.00 1 month ago Morgan Hill, CA $80,000.00-$140,000.00 5 hours ago Menlo Park, CA $116,000.00-$166,000.00 2 weeks ago Mountain View, CA $60,000.00-$80,000.00 2 months ago Fremont, CA $31,000.00-$121,000.00 9 months ago Mountain View, CA $65,000.00-$151,527.00 1 week ago San Jose, CA $76,800.00-$160,400.00 2 weeks ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr