Utilization Review Supervisor
Lynwood, CAFull-time$37–49.39/hrPosted todayStill listed today
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Job overview
The Utilization Review Supervisor oversees third-party payer utilization review and denial management, including authorization appeals and compliance protocols. The role supervises the UR process, monitors and reports clinical denials, and coordinates with Case Management, Business Office, and Coding teams. It also participates in stakeholder meetings, conducts audits, and develops process-improvement plans. The posting requires a minimum of one year as a clinical documentation specialist or utilization review coordinator.
Skills & qualifications
Skills
Qualifications
Benefits
Full job description
Overview
Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! St. Francis Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.
St. Francis Medical Center is one of the leading comprehensive healthcare institutions in Los Angeles. St. Francis provides vital healthcare services for the 700,000 adults and 300,000 children in our community who count on the hospital for high quality and compassionate medical care. St. Francis is recognized for its full range of diagnostic and treatment services in specialties including Cardiovascular, Surgical, Orthopedics, Obstetrics, Pediatrics, Behavioral Health, and Emergency and Trauma Care. In addition, the hospital offers a broad array of education and outreach programs that advance community health. St. Francis Medical Center is a Comprehensive Stroke Center, STEMI Receiving Center, ED Approved for Pediatrics, Geriatric ED, Level III Neonatal ICU, and Level II Trauma Center. Please visit www.stfrancismedicalcenter.com for more information. Join an award-winning team of dedicated professionals committed to compassion, quality, and service!
Responsibilities
The UR Supervisor is responsible to provide an oversight of third-party payer Utilization Review (UR) and the denial management (DM) process. This role will actively supervise and coordinate the front end to back denial management initiatives including Utilization review, Authorization Appeals and compliance protocols. Providers supervision and direction for UR process along with analysis, resolution, monitoring & reporting of clinical denials. Serves as a liaison between Case Management, Business Office and Coding teams to ensure timely reporting and tracking/follow up of denials Participate in regular Utilization committee and Came Management meeting with stakeholders from all department and Corporate leadership team to provide necessary education and discuss progress and protocols for Insurance authorization and denial prevention strategies. Performs ongoing audits to monitor UR and appeal/denial process and develops process improvement plans for identified deficiencies. Knowledge of Federal, State and intermediary guidelines related to inpatient acute care hospitalization as well as lower levels of care for the continuity of treatment. Performs other duties are assigned.
Qualifications
EDUCATION, EXPERIENCE, TRAINING
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Medical Graduate, Dental Graduate, Physician Assistant, Nursing Graduate required.
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ECFMG Certification And/or bachelor's or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
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Utilization Review experience is highly preferred.
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Denial Management experience preferred.
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Minimum of one-year experience as a clinical documentation specialist or utilization review coordinator.
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1+ year of clinical experience in acute care setting preferred.
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Excellent written and verbal communication skills. Excellent critical thinking skills.
Pay Transparency
St. Francis Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $37.00 to $49.39. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status Full Time Shift Days Equal Employment Opportunity
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
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