Utilization Review (UR) Assistant

College Medical Center -

This position supports the Mission of the Hospital through the provision of distinctive and compassionate care to our patients. This position provides clerical support to the Case Management Department by assuring continuous flow of daily activities; duties and information flow between all hospital departments and external customers. Perform various clerical tasks utilizing knowledge of office systems and procedures, facility regulations, and interdepartmental functions.

QUALIFICATIONS:

• High School graduate or GED preferred

• One year experience in an acute care hospital or related healthcare filed preferred

• Knowledge of medical terminology required

MAJOR TASKS, DUTIES, AND RESPONSIBILITIES:

• Responsible for processing all TARS in BHU after patient discharges

• Confirms MediCal TARS are completed for all dates of service and requests follow-ups from case managers as needed

• Prepare face sheets and print eligibility for patients and coordinates with HIM to request necessary medical records

• Submit MediCal TAR to MediCal field office via courier

• Prepares MediCal appeal decisions involving upheld denied days for further appeal

• Processes adjudication responses and appeal decisions from MediCal upon receipt to case management

• Completes data entry in revenue cycle of Cerner to document TARS submission

• Monitors MediCal case lists on a weekly basis to verify the status of TARS needed to be completed and status on TARS needing appeals and follow-up

• Assemble and maintain departmental files, logs, and manuals

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for CMC roles, including but not limited to shift differential and other special pay practices, etc. The posted compensation for the position is a reasonable estimate that extends from the lowest to the highest pay that CMC in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.

EEO Statement

All College Medical Center subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. College Medical Center subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

Notice

We are aware of a scam whereby imposters are posing as Recruiters from College Medical Center, and our subsidiary hospitals and facilities. Beware of anyone requesting financial or personal information.

At College Medical Center and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at College Medical Center and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. Email correspondence will come from the domains @collegemedicalcenter.com or @glendorahospital.com.

If you suspect a fraudulent job posting or job-related email mentioning College Medical Center or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate College Medical Center subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.