Utilization Review Technician UR Case Management

ABOUT THE POSITION

The County of Riversides - RUHS-Medical Center Department is seeking a Utilization Review Technician to support the UR Case Management Division in Moreno Valley.

Under general supervision performs a variety of clerical and data collection tasks and acts as a liaison between providers medical staff and insurance plans in support of Utilization Management and professional staff of Riverside University Health System (RUHS); performs other related duties as required.

The Utilization Review Technician is a journey level classification and reports to an appropriate supervisory or manager level position. Incumbents respond to inquiries and concerns of the health plan members and is the primary liaison between the health plan member and network addition this class monitors patient treatment records and follows up with physicians or nursing staff to ensure that documentation is provided or a determination is made as to medical necessity and appropriateness of services.

Essential Duties include the following:

• General office and administrative support
• Inventory control and purchasing
• Scheduling and timekeeping
• Other duties as assigned

Desired Qualifications:

• Microsoft 365 proficiency (Word Excel Teams)
• Strong organizational skills

Work Schedule: Will be discussed during the interview; Tentative 5/40 8:00 AM 4:30 PM rotating weekends and holidays required.

Meet the Team!
Every day at Riverside University Health System Medical Center a dedicated team of healthcare professionals and support staff come together to improve lives across Riverside County. Our nationally recognized programs and specialized services thrive because of the diverse talents and commitment of our team members. No matter your background or skill set youll discover meaningful opportunities and a strong sense of purpose here.

To learn more about RUHS Medical Center please visit

EXAMPLES OF ESSENTIAL DUTIES

Record intake information on the phone from providers requesting referral and/or authorization and refer requests to nursing staff and/or Medical Director or give authorization according to specified criteria following physician or nursing staff directions.

Monitor and maintain Medi-CAL Treatment Authorization Requests (TARs) backlog and Commercial Insurance backlog; refer TARs to Case Manager for resubmission.

Act as a liaison and resource to other departments contracted hospitals insurance companies subsidized programs etc. relative to the work of the department.

Monitor insurance listed within patients Emergency Medical Records (EMR) and notify Integrated Care Management (ICM) team members regarding insurance changes; assist in obtaining authorizations and approval for inpatient stays and document authorizations in the EMR.

Work with medical staff to complete patient charts and forms; compare medical record documentation with professional standards of care as outlined by the utilization review nurse manager or physician.

Issue Important Message (IM) and Medicare Outpatient Observation Notice (MOON) letters for Medicare beneficiaries.

Coordinate Durable Medical Equipment (DME) prescriptions with RUHS staff and insurance companies/payor source.

Monitor and maintain California Children Services (CCS) database document authorizations/denials from CCS and make referrals for all patients under 21 with qualifying CCS diagnosis.

Promote continuity of care by transmitting all Discharge Summaries to insurance providers.

MINIMUM QUALIFICATIONS

OPTION I

Education: Graduation from high school or attainment of a satisfactory score on a G.E.D test.

Experience: Six months of clinical billing or medical office administration experience in a healthcare or a Health Maintenance Organization.

OPTION II

Education: Graduation from high school or attainment of a satisfactory score on a G.E.D test.

Experience: One year of clerical experience.

Knowledge of: General policies of health coverage limits related to managed care and HMO standards; hospital registration reimbursement or referral practices and procedures; eligibility requirements of subsidiary programs such as Managed Care Medi-Cal Medicare CCS etc.; general interviewing techniques and telephone etiquette; computer programs including use of database and word processing; proper English usage style grammar punctuation and spelling.

Ability to: Learn specialized medical terminology project indicators and office procedures; perform a variety of clerical duties and work effectively under stressful conditions; communicate effectively in providing information and assisting the public; interact with public service providers members of the public and staff in a courteous effective manner.

SUPPLEMENTAL INFORMATION

APPLICATION INFORMATION

Veterans Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify upload a copy of your (or your spouses) Member-4 Form DD-214 indicating dates of service and a copy of your spouses letter of disability (if applicable) with your application. For privacy reasons it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans Veterans Preference Policy C-3 is available here: Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation please visit the Disability Access Office web page located at: of Education
If using education to qualify or when requested by the recruiter upload a copy of any license(s) official/unofficial transcript(s) degrees and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.

If your education was completed outside of the United States you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services (NACES) or Association of International Credential Evaluators Inc. (AICE).

Work Authorization Requirement
Applicants must be legally authorized to work in the United States at the time of application. The County of Riverside does not participate in visa sponsorship programs including H1-B visas and will not provide sponsorship for any employment-based visas.

Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race color religion sex national origin age disability sexual orientation gender gender identity gender expression marital status ancestry medical condition (cancer and genetic characteristics) genetic information or denial of medical and family care leave or any other non-job-related factors.

Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment physical examination and background check may be required.

Probationary Period
As an Approved Local Merit System all County of Riverside employees except those serving At Will are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding County Resolution or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.

General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.

Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.

Please read and follow any special application instructions on this posting. Click the Apply link located on this page to submit your application. For additional instructions on the application process examinations Veterans preference pre-employment accommodation or other employment questions please refer to our web site .

If you are experiencing technical problems you may contact the applicant support desk Monday through Friday 6 am to 5 pm Pacific Time at or toll-free 1-.