Utilization Management Coordinator

Ocean view psychiatric hospital; Long Beach (CA); On-site; USD 36,000 - 39,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401(k) retirement plan

Professional growth and training

Job summary

Ocean View Psychiatric Hospital in Long Beach, CA, is seeking an Utilization Review professional for on-site, 8-hour shifts. You will review clinical documentation, determine medical necessity, and coordinate with payers to ensure appropriate level-of-care for both inpatient and outpatient services.

The role requires strong clinical judgment, communication, organization, and time-management, with collaboration across payers, providers, and the healthcare team.

Qualifications

• High School Diploma or GED required.
• ICD-10 Coding Knowledge or Certification.
• Billing and Coding Knowledge or Certification.
• Medical Records Knowledge or Certification.
• Ability to interact and communicate verbally and in writing with seriously and persistently mentally ill patients, other staff members, and the public.
• Ability to speak, read, and write legibly in English.
• Minimum of two (2) years of experience in behavioral health, healthcare, or hospital settings.
• Strong teamwork and collaboration skills across disciplines and departments.
• Proficiency in the use of computers and standard keyboard functions for data entry and electronic documentation.
• Experience using Electronic Health Records (EHR) systems for documentation and coordination of care.

Responsibilities

• Extensive experience in insurance eligibility and benefits.
• Maintain accurate patient and payer records.
• Submit 24-hour notification into LA County TAR Unit Database.
• Complete and submit TAR forms accurately.
• Print or upload patient medical records as required.
• Track submissions to ensure timely processing and approval or denial status updates.
• TAR Tracking & Compliance.
• Monitor deadlines and ensure compliance with all timelines.
• Manage denials by tracking appeal deadlines, preparing, and submitting appeal TARs.
• Maintain tracking logs for all initial and appeal TARs.
• Support the Structured Outpatient Services Program (IOP/PHP) based on census fluctuations.

Skills

ICD-10 Coding

Billing & Coding

Medical Records

EHR Systems

English Proficiency

Healthcare Experience

Teamwork

Computer Proficiency

Data Entry

Communication Skills

Education

Bachelor's degree in Health Information Management (HIM)

Job description

Location: On-Site inLong Beach, CA
Schedule: 8-hour shifts

Pay Range: $26.00-28.00 hourly

PositionSummary

Our Utilization Review department manages both outpatient and inpatient patients. We work with Medicare, Medicare HMO, Medi-Cal , commercial insurance, including Medicare recertifications and other insurance authorization requirements. This role reviews clinical documentation, medical necessity, communicating with insurance companies, and ensuring patients meet the appropriate level-of-care criteria. The UR team works closely with providers, case management, and the clinical team to coordinate care, address insurance requirements, and support the best possible patient outcomes.

This position requires strong clinical judgment, communication, organization, critical thinking, and time-management skills, as well as the ability to collaborate effectively with payers, providers, and the healthcare team.

Make a difference by providing quality care alongside us at Ocean View!

Key Responsibilities

• Extensive experience in insurance eligibility and benefits
• Maintainaccuratepatient and payer records
• Submit24-hour notificationinto LA County TAR Unit Database
• Complete andsubmitTAR forms accurately
• Print or upload patient medical records asrequired
• Track submissions to ensureTimely processingandApproval or denial status updates
• TAR Tracking & Compliance
• Monitor deadlines and ensure compliance with all timelines
• Manage denials bytracking appeal deadlines,preparing,andsubmittingappeal TARs
• Maintain tracking logs for allinitialand appeal TARs
• While primarily assigned to the inpatient unit, may berequiredto support the Structured Outpatient Services Program (IOP/PHP) based on census fluctuations and departmental needs

Minimum Qualifications

• High School Diploma or GED required
• ICD-10 Coding Knowledge or Certification
• Billing and Coding Knowledge or Certification
• Medical Records Knowledge or Certification
• Ability to interact and communicate verbally and in writing with seriously and persistently mentally ill Patients, other staff members, and the public.
• Ability to speak, read, and write legibly in English.
• Minimum of two (2) years of experience inbehavioralhealth, healthcare, orhospitalsettings.
• Strong teamwork and collaboration skills across disciplines and departments.
• Proficiencyin the use of computers and standard keyboard functions for data entry and electronic documentation.
• Experience using Electronic Health Records (EHR) systems for documentation and coordination of care.

Preferred Qualifications

• Bachelorsdegree in health information management, healthcare administration, or relatedhealthcare field.
• Bilingual English/Spanish+.
• Excellent verbal and written communication as well as strong interpersonal and organizational skillsrequired.
• PreviousJCAHO experience preferred.
• Prior experience using Electronic Health Records (EHR) systems for documentation and coordination of care.

Benefits

• Comprehensive medical, dental, and vision insurance for qualifying employees
• 401(k) retirement savings plan
• Supportive, team-oriented work environment
• Opportunities for professional growth, training, and advancement within the organization

Special Conditions

• Employment is contingent upon successful completion of Live Scan fingerprinting, background check clearance, and verification of required licenses, certifications, and education
• Satisfactory completion of professional reference checks
• Must be legally authorized to work in the United States; Ocean View does not provide visa sponsorship for certain roles unless otherwise specified
• Compliance with all applicable federal, state, and local regulations, including California Department of Health Care Services (DHCS), The Joint Commission, and HIPAA standards
• Compliance with all required health screenings and immunizationsin accordance withregulatory guidelines and facility policy, which may include tuberculosis (TB) testing, N95 fit testing, annual trainings, and proof of vaccination for certain communicable diseases
• Availability to workweekends based on operational or patient care needs
• Demonstrate understandingand becompliant with Patients' Rights, LPS Statutes, and Seclusion and Restraint Protocols.