Utilization Review Technician III

Prime Healthcare; Ontario; On-site; CAD 30,000 - 60,000; Full time

Job summary

An established industry player is seeking a Utilization Review Tech to join their dynamic team. This full-time, in-office role is pivotal in coordinating the utilization review and appeals process, ensuring seamless communication with insurance providers, and supporting various departmental functions. Ideal candidates will possess a Bachelor's degree or relevant experience, alongside proficiency in Microsoft Office and strong communication skills. Join a forward-thinking health system that values its employees and offers competitive compensation and comprehensive benefits, including paid time off and tuition reimbursement.

Benefits

Paid Time Off

401K

Medical Coverage

Dental Coverage

Vision Coverage

Tuition Reimbursement

Qualifications

• Bachelor’s degree or four years of relevant experience required.
• Proficiency in Microsoft Office and good communication skills.

Responsibilities

• Coordinate the utilization review and appeals process.
• Manage communication with insurance providers and track authorization.

Skills

Microsoft Office

Communication Skills

Education

Bachelor’s Degree

Relevant Experience (4 years)

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. It operates 51 hospitals and over 360 outpatient locations across 14 states, providing more than 2.5 million patient visits annually. With nearly 57,000 employees and physicians, it is one of the nation's leading health systems. Eighteen of its 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 employment opportunity employer. Discrimination based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (as per law), disability, military status, genetic information, or any other protected category is prohibited. We also prohibit harassment related to these categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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

Responsibilities

The Utilization Review Tech coordinates the utilization review and appeals process as part of denial management initiatives. This role involves serving as a liaison, managing communication with insurance providers, data entry, mailing/faxing appeals, and tracking authorization, expedited reviews, and appeals. The Tech documents and tracks all communication attempts and correspondence, working closely with the utilization review teams, Business Office, and Case Managers. Additionally, the Tech maintains the integrity of government review audits and other payer audits. The role also includes supporting the department with Release of Information, discharge coordination, and other duties as assigned.

This role is full-time and based in-office.

Qualifications

• Bachelor’s degree or four years of relevant experience.
• Proficiency in Microsoft Office.
• Good communication skills.

Preferred qualifications:

• Completion of a medical terminology course.
• Knowledge of HIPAA regulations.

We are an Equal Opportunity/Affirmative Action Employer. We do not discriminate based on veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. For accommodations, contact Human Resources. EEO Law: https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf

Prime Healthcare Management Inc. offers competitive compensation and a comprehensive benefits package, including paid time off, 401K, medical/dental/vision coverage, tuition reimbursement, and more. The estimated total compensation range for this role is $23.15 to $33.64, depending on experience, education, and credentials.