Clinical Review Coordinator
1 month ago
The Clinical Review Coordinator will play a crucial role in coordinating the utilization review and appeals process as part of the denial management initiatives. This position will serve as a liaison and own the coordination with other UR techs in the team, while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals.
Key Responsibilities- Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool.
- Follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers.
- Coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned.
- Function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable.
- Support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.
- Bachelor's degree or four years of relevant experience required.
- Microsoft office proficiency.
- Good communication skills.
- Completion of a medical terminology course; preferred.
- Knowledge of HIPAA regulations preferred.
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Utilization Review Coordinator
3 days ago
Ontario, California, United States Prime Healthcare Full timeJob SummaryWe are seeking a highly skilled Utilization Review Technician III to join our team at Prime Healthcare. As a key member of our denial management initiatives, you will play a critical role in coordinating the utilization review and appeals process.ResponsibilitiesCoordinate phone calls, data entry, mailing/faxing appeals, and tracking data from...
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Utilization Review Coordinator
4 weeks ago
Ontario, California, United States Prime Healthcare Management Inc Full timeJob SummaryThe Utilization Review Coordinator is a key role within Prime Healthcare Management Inc, responsible for implementing and managing the utilization review program for the employee medical benefit program.ResponsibilitiesAssist in the direction and utilization of available resources to provide quality, cost-effective care using selected benefits and...
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Clinical Quality Assurance Manager
4 weeks ago
California, United States Advanced Clinical Full timeJob SummaryWe are seeking a highly skilled Clinical Quality Assurance Manager to join our team at Advanced Clinical. As a key member of our organization, you will be responsible for ensuring the highest level of quality and compliance in our clinical studies.Key ResponsibilitiesAudit Strategy Development: Identify and prioritize audit strategies for GCP...
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Utilization Review Coordinator
4 weeks ago
Ontario, California, United States Prime Healthcare Full timeAbout Prime HealthcarePrime Healthcare is a leading health system headquartered in Ontario, California, operating 45 hospitals and over 300 outpatient locations in 14 states, providing more than 2.6 million patient visits annually.Job SummaryWe are seeking a skilled Utilization Review Coordinator to join our team. The successful candidate will be responsible...
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Clinical Coordinator
6 days ago
Ontario, California, United States DaVita Full timeJoin DaVita's Team as a Clinical CoordinatorWe are seeking a skilled and compassionate Clinical Coordinator to join our team at DaVita. As a Clinical Coordinator, you will play a vital role in delivering high-quality patient care and services in our outpatient dialysis center.About the RoleAs a Clinical Coordinator, you will be responsible for coordinating...
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Clinical Speech Therapist Position
1 month ago
Ontario, California, United States Clinical Management Consultants Full timeAbout UsClinical Management Consultants is a leading healthcare organization dedicated to providing exceptional patient care and services. Our team of professionals is committed to delivering high-quality care to individuals of all ages.Job OverviewWe are seeking a highly skilled Speech Therapist to join our multidisciplinary team. The successful candidate...
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Clinical Services Coordinator
2 weeks ago
California, United States Blue Shield of California Full timeYour RoleThe Blue Shield of California team is seeking a skilled Clinical Services Coordinator to support the Children's Health Program (CHP). As a key member of the CHP team, you will work closely with clinical staff to ensure seamless care management for Medi-Cal members under 21 years old.Your ResponsibilitiesProcess and manage authorizations, referrals,...
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Healthcare Utilization Review Specialist
2 weeks ago
Ontario, California, United States Prime Healthcare Full timeJoin Prime Healthcare as a Utilization Review CoordinatorPrime Healthcare is a leading health system with a strong commitment to quality patient care. As a Utilization Review Coordinator, you will play a critical role in ensuring that our patients receive the best possible care while minimizing unnecessary costs.Key Responsibilities:Conduct thorough reviews...
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Product Review Engineer
7 days ago
Ontario, California, United States IAPMO Full timeAbout IAPMOWe are a community of plumbing experts dedicated to advancing the latest methods of sanitation and ensuring access to clean water and sanitation through our testing and certification efforts.Job DescriptionOur Research and Testing Department is seeking a talented Product Review Engineer I to join our certification team. As a Product Review...
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Clinical Care Coordinator
3 weeks ago
Irvine, California, United States University of California, Irvine Full timeJob SummaryWe are seeking a highly skilled Clinical Care Coordinator to join our team at the University of California, Irvine. As a Clinical Care Coordinator, you will play a critical role in coordinating the delivery of high-quality, individualized patient care.Key ResponsibilitiesCollaborate with attending and resident medical staff, as well as nursing,...
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Product Review Engineer
2 days ago
Ontario, California, United States IAPMO Full timeJob Title: Product Review Engineer IWe are seeking a highly skilled Product Review Engineer I to join our Research and Testing Department (R&T) certification team.Job Summary:The Product Review Engineer I will be responsible for performing product reviews for a variety of plumbing, mechanical, and electro-plumbing products to ensure compliance with industry...
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Clinical Services Coordinator, Intermediate
3 weeks ago
California, United States Blue Shield of California Full timeAbout the RoleThe Children's Health Program (CHP) team at Blue Shield of California provides identification, referrals, and care management for all Medi-Cal members under 21 years old. As a Clinical Services Coordinator Intermediate, you will work closely with clinical staff to support member needs using established and approved medical policies and...
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Clinical Services Coordinator
3 days ago
California, United States Blue Shield of California Full timeAbout the RoleThe Clinical Services Coordinator will play a vital role in supporting the Children's Health Program (CHP) team in providing identification, referrals, and care management for Medi-Cal members under 21 years old. This position will collaborate with clinical staff to ensure member needs are met, utilizing established Blue Shield Medical Policies...
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Clinical Services Coordinator, Intermediate
2 days ago
California, United States Blue Shield of California Full timeAbout the RoleThe Blue Shield of California team is seeking a skilled Clinical Services Coordinator, Intermediate to join our Children's Health Program (CHP) team. In this role, you will work closely with clinical staff to support member needs, utilizing established and approved medical policies and guidelines that align with nationally recognized...
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Clinical Supervisor
2 weeks ago
Ontario, California, United States Marsell Wellness Center Full timeJob SummaryMarsell Wellness Center is seeking a highly skilled Clinical Supervisor to lead our therapy services team. As a key member of our leadership team, you will be responsible for providing clinical supervision, training, and support to our therapists and case managers.Key ResponsibilitiesDevelop and implement clinical policies and procedures to ensure...
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Medical Benefits Coordinator
3 weeks ago
Ontario, California, United States Prime Healthcare Management Inc Full timeOverviewPrime Healthcare Management Inc is a leading health system with a strong commitment to providing quality, cost-effective care to its patients. We are seeking a highly skilled Utilization Review Coordinator to join our team.ResponsibilitiesThe Utilization Review Coordinator will be responsible for assisting with the implementation and ongoing...
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Clinical Services Coordinator, Intermediate
1 month ago
California, United States Blue Shield of California Full timeAbout the RoleThe Blue Shield of California team is seeking a skilled Clinical Services Coordinator Intermediate to join our Children's Health Program (CHP) team. In this role, you will work closely with clinical staff to support member needs, utilizing established and approved medical policies and guidelines that align with nationally recognized...
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Referral Coordinator
3 days ago
Ontario, California, United States Unicare Community Health Center Full timeJob Title: Referral CoordinatorWe are seeking a highly skilled Referral Coordinator to join our team at Unicare Community Health Center. As a Referral Coordinator, you will play a critical role in ensuring that patients receive the necessary care and services in a timely and efficient manner.Job Summary:The Referral Coordinator will be responsible for...
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Nursing Skills Lab Coordinator
4 weeks ago
Ontario, California, United States West Coast University, Inc. Full timeNursing Skills Lab Coordinator Job DescriptionJob Summary:We are seeking a highly skilled and experienced Nursing Skills Lab Coordinator to join our team at West Coast University, Inc. The successful candidate will be responsible for coordinating clinical learning lab facilities and services in the nursing program.Key Responsibilities:Coordinate day-to-day...
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Clinical Research Coordinator
4 weeks ago
Orange, California, United States University of California, Irvine Full timeAbout the RoleWe are seeking a highly organized and detail-oriented Clinical Research Coordinator to join our team at the University of California, Irvine. As a Clinical Research Coordinator, you will play a critical role in the coordination of clinical trials, ensuring the smooth execution of research projects from initiation to completion.Key...