Utilization Review Coordinator II

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one 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!

Responsibilities

The Utilization Review Coordinator II (URC II) serves as a Subject Matter Expert (SME) in the overall Utilization Review (UR) process, including authorization, appeals, and denial management processes across all payors. Particularly responsible for overseeing more complex accounts and ensuring timely, accurate resolution of authorization and appeal matters while monitoring data and performance metrics to identify trends, root causes, and opportunities for process improvement. Provides analytical findings and recommendations to department leadership to support operational goals and effective denial management strategies. Works collaboratively with multiple stakeholders, including Corporate, Facility, and Remote UR/CM teams, Business Office, Case Managers, Physicians, and Administration, and serves as a more experienced representative of the UR team for Medicare, Medicaid, Managed Care, and commercial payors. Provides guidance and education to UR staff and assists department leadership with implementation of process improvements, performance initiatives, and departmental goals. Performs other duties as assigned.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required Qualifications:

 

Bachelor’s degree in Health Information Management, Pharmacy, Social Services, Physical Therapy and Respiratory Therapy.

Two years of Utilization Review experience as a Utilization Review Coordinator is required.

Microsoft Office proficiency.

Strong communication skills.

 

Preferred Qualifications:

Completion of a medical terminology course.

Knowledge of HIPAA regulations.

Excellent written and verbal communication skills. Excellent critical thinking skills.

Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.

Ability to work independently in a time-oriented environment.

Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred. 

Pay Transparency

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 $31.50 to $42.53. 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.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf