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Utilization Review Specialist

2 months ago

Bakersfield, California, United States Good Samaritan Hospital Full time
Job Title: Utilization Review Clerk

Good Samaritan Hospital is seeking a detail-oriented and organized Utilization Review Clerk to join our team. As a key member of our Utilization Review department, you will play a critical role in ensuring compliance with State and Federal regulatory requirements.

Job Summary:

The Utilization Review Clerk will be responsible for performing internal audits, assisting with special projects, and generating reports to validate program integrity. You will work closely with the Utilization Review Manager to develop and maintain operational policies and procedures.

Key Responsibilities:
  • Assist with TAR completion and UR logs
  • Ensure accurate chart documentation for hospitalization criteria
  • Perform audits and gather data for compliance and program process validation
  • Receiving incoming phone calls for admissions
  • Data entry as required
Requirements:

To be successful in this role, you will need:

  • High school graduate or equivalent
  • Ability to stay organized and shift priorities as needed
  • Proficiency in Windows-based programs, especially Excel
  • Excellent general office skills
  • Effective communication skills in both written and oral formats
  • Ability to work independently
Physical Demands:

This role requires minimal physical activity and is classified as a Low Strength Rating. However, you may be exposed to musculoskeletal injuries due to moving or lifting supplies and equipment, as well as potential exposure to infectious processes and hazardous substances within the hospital environment.