Utilization Review Coordinator jobs in Fresno, CA

Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)

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Utilization Review Coordinator, Behavioral Health
  • Community Health System - CA
  • Fresno, CA FULL_TIME
  • Overview:
    • All positions are located in Fresno/Clovis CA*
    Opportunities for you!

    Join a Forbes Top 10 CA Employer!
    Free Continuing Education and certification including BLS, ACLS and PALS
    Tuition reimbursement, education programs, and scholarships
    Vacation time starts building on Day 1, and builds with your seniority
    403(b) retirement plan with up to 8% matching contributions
    Free parking and electric charging
    Great food options with on-demand ordering
    Commitment to diversity and inclusion is a cornerstone of our culture at Community. All are welcome as valued members of our community.

    We know that our ability to provide the highest level of care begins with taking care of our incredible teams. Want to learn more? Click here.

    Responsibilities:
    The Behavioral Health Utilization Review Coordinator is responsible for various aspects of utilization management to ensure that care is rendered in accordance with intensity of service and severity of illness standards at all times during the stay. Works collaboratively with the Case Management team, other departments, and physicians to facilitate efficient and appropriate management of all cases.

    Accountabilities

    1. Reviews the patient care plan of patients who are under treatment for emotional or mental illness to ensure proper utilization of treatment resources.

    2. Processes patient authorizations, denials and appeals.

    3. Performs prospective, concurrent and retrospective reviews to determine medical necessity and submits clinical patient information to obtain approval of days and ensure reimbursement for continued inpatient psychiatric treatment according to federal, state and county regulations.

    4. Identifies documentation deficiencies, admission screening issues, physician practice patterns, case management, and intensity of service issues contributing to payment denials.

    5. Issues denial letters in accordance with policies, procedures and regulatory guidelines. Informs client and/or responsible party of right to appeal and the appeal process.

    6. Monitors the length of stay and costs associated per case. Monitors financial aspect of utilization and retrospective review.

    7. Responsible for analysis and reporting of utilization data (denial, reimbursement, Potentially Avoidable days).

    8. Collaborates with physicians, Case Management and other teams as needed to expedite timely resolution of situations to include, inappropriate admissions, intensity of service issues and with questions regarding appropriate utilization management.

    9. Performs other job-related duties as assigned.

    Qualifications:
    Education
    • Bachelor's Degree in Social Work (BSW) or related field required
    • Master's Degree in Social Work (MSW) or related field preferred
    Experience
    • 2 years of experience in Discharge Planning, Case Management or Utilization Management required
    • Experience in the utilization review process and insurances preferred
    • Experience in a Behavioral Health environment is preferred
    Disclaimers:
    • Pay ranges listed are an estimate and subject to change.
    • If any bonuses are noted, they are only applicable to external hires meeting criteria.
  • 20 Days Ago

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Utilization Review Coordinator, Behavioral Health
  • Community Medical Centers of Fresno, CA
  • Fresno, CA OTHER
  • Overview *All positions are located in Fresno/Clovis CA* Opportunities for you! Join a Forbes Top 10 CA Employer! Free Continuing Education and certification including BLS, ACLS and PALS Tuition reimb...
  • 1 Month Ago

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UTILIZATION REVIEW SPECIALIST
  • County of Fresno
  • Fresno, CA FULL_TIME
  • Scheduled Salary Increases:Step 6 effective 7/8/24 ($97,110 - $123,942 Annually)3% effective 1/20/25 ($100,022 - $127,660 Annually)APPLY IMMEDIATELY AS THE RECRUITMENT MAY CLOSE AT ANY TIMEAPPLICATION...
  • 1 Day Ago

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Utilization Review and Intake Specialist
  • My Time Recovery
  • Fresno, CA FULL_TIME
  • Utilization Review Specialist and Intake Coordinator Job Description Conduct thorough reviews of client treatment plans to ensure alignment with established clinical guidelines, insurance requirements...
  • 1 Month Ago

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Interim Utilization Review RN Manager
  • FirstChoice
  • Fresno, CA CONTRACTOR,TEMPORARY,FULL_TIME
  • Are you an Acute Care Utilization Review RN Manager seeking your next adventure? Duration: 13-week Assignment This key leadership role, is responsible for management, leadership, and coordination of t...
  • 6 Days Ago

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LVN Utilization Review Specialist, Behavioral Health
  • Community Medical Centers of Fresno, CA
  • Fresno, CA OTHER
  • Overview *All positions are located in Fresno/Clovis CA* Opportunities for you! Free Continuing Education and certification including BLS, ACLS and PALS Tuition reimbursement, education programs, and ...
  • 23 Days Ago

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0 Utilization Review Coordinator jobs found in Fresno, CA area

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RN Supervisor, Surgery
  • Community Health System - CA
  • Fresno, CA
  • Overview: *All positions are located in Fresno/Clovis CA* Opportunities for you! Direct impact on quality patient care w...
  • 3/28/2024 12:00:00 AM

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RN Nurse Supervisor, Med Surg, Acute Care, $10K Sign on
  • Community Health System - CA
  • Fresno, CA
  • Overview: *All positions are located in Fresno/Clovis CA* Community Medical Centers has been providing central Californi...
  • 3/28/2024 12:00:00 AM

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Referral Coordinator/Medical Assistant
  • Sante Health
  • Fresno, CA
  • Sante Health System is looking to add a full-time Referral Coordinator/Medical Assistant to join our medical office team...
  • 3/27/2024 12:00:00 AM

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HR Specialist (Temp)
  • Family HealthCare Network
  • Visalia, CA
  • Job Description Description of Primary Responsibilities Responsible for carrying out responsibilities in the following f...
  • 3/27/2024 12:00:00 AM

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Bookkeeper/Administrative Assistant
  • Turning Point of Central California
  • Fresno, CA
  • Turning Point of Central California, Inc. was founded in 1970. For over 50 years now, we have been transforming lives ac...
  • 3/26/2024 12:00:00 AM

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Healthcare Coordinator
  • Pacific Dental Services
  • Fresno, CA
  • Description: Now is the time to join Marketplace Smiles Dentistry and Orthodontics. You will have opportunities to learn...
  • 3/26/2024 12:00:00 AM

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Front Desk Receptionist
  • Sante Health
  • Fresno, CA
  • Sante Health System is looking for a full time Front Desk Receptionist in the Fresno, CA area to join our medical office...
  • 3/25/2024 12:00:00 AM

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LEM Administrative Assistant VII
  • The Judge Group
  • Lemoore, CA
  • Job Title: Administrative Assistant VII Summary Description: The Administrative Assistant provides high quality, collabo...
  • 3/25/2024 12:00:00 AM

Fresno (/ˈfrɛznoʊ/ FREZ-noh; Spanish for "ash tree") is a city in California, United States, and the county seat of Fresno County. It covers about 112 square miles (290 km2) in the center of the San Joaquin Valley, the southern portion of California's Central Valley. Named for the abundant ash trees lining the San Joaquin River, Fresno was founded in 1872 as a railway station of the Central Pacific Railroad before it was incorporated in 1885. The city has since become an economic hub of Fresno County and the San Joaquin Valley, with much of the surrounding areas in the Metropolitan Fresno regi...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$80,831 to $100,122
Fresno, California area prices
were up 2.7% from a year ago

Utilization Review Coordinator in Fort Lauderdale, FL
Some review coordinator positions require that professionals have training and experience within a more specific field.
January 10, 2020
Utilization Review Coordinator in Asheville, NC
Schick Shadel Hospital is seeking a part-time (20 hours per week) Utilization Review Coordinator (UR Coordinator) to help oversee and perform the process of utilization review to ensure appropriate reimbursement by third party payers.
January 04, 2020
Utilization Review Coordinator in Jacksonville, FL
Excellent benefits, pay, small on-site employee gym, wonderful co-workers and managersFull Review.
January 04, 2020