Utilization Review Tech II

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Garden Grove Hospital 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.

Founded in 1982, Garden Grove Hospital Medical Center is a 167-bed community hospital centrally located in beautiful Southern California dedicated to providing our community with high-quality, compassionate healthcare. Garden Grove Hospital Medical Center has received "Top 100 Hospital" in the nation accolades from Truven Health Analytics and is a recipient of the Patient Safety Excellence Award from Healthgrades. Key services include general medical/surgical inpatient care and treatment, critical care, emergency services, orthopedics, maternity care, and wound care.

The facility offers a full spectrum of acute care services for the residents of Garden Grove and the surrounding communities. Located near the corner of Harbor and Garden Grove Boulevards, Garden Grove Hospital is close to the Disneyland Resort, the Anaheim Convention Center, and the many hotels situated in the area. For more information, visit gardengrovehospital.com.

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 for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, data entry and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and 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. The Utilization review tech will further support the department needs for Release of Information, discharge coordination or other duties as assigned.

EDUCATION, EXPERIENCE, TRAINING

1. High School Diploma or equivalent required.
2. Associates degree or higher preferred.
3. Two years of relevant experience required
4. Accurate alphabetic, numeric, and/or terminal-digit filing skills.
5. Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.
6. Knowledge of terminal digit filing and medical terminology; preferred.
7. Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.
8. Completion of a medical terminology course; preferred.
9. Background in business and office training; preferred.

Garden Grove Hospital 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 $22.05 to $28.60. 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.