Utilization Review & Care Coordination Specialist

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

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.