Utilization Review Coordinator Utilization Review Coordinator Arcata, CA

TimeTrex (TimeTrex Software Inc.); Arcata (CA); On-site; USD 75,000 - 95,000; Full time

Job summary

Mad River Community Hospital in Arcata, California, seeks a Utilization Review Coordinator to oversee and evaluate utilization review activities within inpatient care settings. The role requires collaboration with health plans and providers to ensure proper resource use and effective discharge planning.

Candidates should hold a Bachelor or Master’s degree in a related field, possess current clinical licensure, and have experience in utilization or case management. Proficiency in electronic records and MS Office is essential.

Join a family-oriented workplace committed to exceptional patient care!

Qualifications

• Bachelor or Master’s degree in Nursing, Social Work, Sociology, or related field from an accredited school.
• Current clinical licensure, either Registered Nurse or Licensed Clinical Social Worker, preferred.
• Previous experience in utilization management, case management, discharge planning and/or home health or rehab preferred.
• Two to five years of recent acute care clinical experience.

Responsibilities

• Collaborates and coordinates with health plans and providers/care teams to ensure appropriate utilization of resources and timely discharge.
• Provides clinical review for different healthcare services requiring authorization.
• Communicates with insurance representatives and third party payers to ensure appropriate authorization for care.
• Develops comprehensive discharge/transitional care plans based on patient assessments.

Skills

Clinical review

Communication with insurance providers

Coordination with care teams

Experience with electronic medical records

MS Office proficiency

Education

Bachelor or Master’s degree in Nursing, Social Work, Sociology, or related field

Job description

Mad River Community Hospital offers a friendly, family‑oriented and welcoming workplace with excellent benefits. Come join our family of dedicated professional staff, where you can take pride in being a part of an exceptional team!

Utilization Review Coordinator reports to the Chief People and Compliance Officer.

The Utilization Review Coordinator is responsible for facilitating, coordinating, integrating and evaluating utilization review activities within the in‑patient acute care setting. The UR Coordinator is part of a team that is accountable for facilitating and providing care coordination services and quality outcomes for patients through discharge planning and transitional care.

Responsibilities

• Collaborates and coordinates with health plans and providers/care teams to ensure appropriate utilization of resources and timely discharge.
• Provides clinical review for different healthcare services requiring authorization, including acute inpatient, skilled nursing facility, acute rehab, and home nursing.
• Communicates with insurance representatives and third party payers to ensure appropriate authorization for care.
• Collaborates and communicates with the care team to develop comprehensive discharge/transitional care plans based on assessment of the patient’s clinical and social needs.
• Demonstrates awareness and ability to articulate legal issues pertaining to patient and families, especially related to non‑covered stay. Issues denial letters as appropriate following approved procedures.

Position Qualifications

• Bachelor or Master’s degree in Nursing, Social Work, Sociology, or related field from an accredited school.
• Current clinical licensure, either Registered Nurse or Licensed Clinical Social Worker, preferred.
• Previous experience in utilization management, case management, discharge planning and/or home health or rehab preferred.
• Two to five years of recent acute care clinical experience.
• Working knowledge of DRG classification system, CPT coding, and INTERQUAL.
• Excellent written and verbal communication skills with the ability to interact with patients/family, clinical staff, insurance providers and post‑acute care providers.
• Capable experience in using electronic medical records.
• Basic proficiency with MS Office, Word and Excel.
• Current BLS certificate.

To Apply

Please apply via our portal by clicking “Apply Now” or email your resume and/or application to HRTeam-at-MadRiverHospital.com.

Equal Opportunity Employer

Mad River Community Hospital provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, national origin, age, sex, sexual orientation, gender identity, disability or genetics. In addition to federal law requirements, Mad River Community Hospital complies with applicable state and local laws governing nondiscrimination in employment. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.