Pediatric Utilization Review Specialist

CHOC; Orange (CA); Hybrid; USD 41,000 - 67,000; Full time

Job summary

CHOC is seeking an Utilization Review Representative for its Main Campus in Orange, CA. The role focuses on utilization review for inpatient and outpatient statuses and processing authorizations with payors, in collaboration with RN Care Managers.

The position requires a CA LVN license and at least two years in acute or ambulatory care, with preference for pediatric nursing experience and UR/case management certification.

Qualifications

• Requires CA LVN license.
• Two years of acute or ambulatory care experience required.
• Nursing background with pediatric exposure preferred.
• UR/case management certification preferred.

Responsibilities

• Perform utilization review for inpatient and outpatient statuses.
• Process internal and external authorization requests with payors.
• Collaborate with RN Care Managers in patient care coordination.
• Assist with data collection, insurance verification, financial counseling and customer service.

Skills

Acute care experience

Ambulatory care

Interpersonal skills

Conflict resolution

Time management

Payor coordination

Microsoft Office

Education

LVN license (CA)

BSN (preferred)

Tools

MS Office

EHR systems

Job description

CHOC is seeking an Utilization Review Representative for its Main Campus in Orange, CA. The role focuses on utilization review for inpatient and outpatient statuses and processing authorizations with payors, in collaboration with RN Care Managers.

The position requires a CA LVN license and at least two years in acute or ambulatory care, with preference for pediatric nursing experience and UR/case management certification.