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Overview

Chino Valley Medical Center is a 112-bed community hospital established in 1972 and centrally located in Southern California’s Chino Valley. A nine-time recipient of the Healthgrades Patient Safety Excellence Award (2014-2022), Chino Valley Medical Center has been recognized nationally for its quality, including as among the 100 Great Community Hospitals by Becker’s Hospital Review in 2018 and as among the 100 Top Hospitals by IBM Watson Health. Chino Valley Medical Center is committed to serving the community’s health care needs with top-rated emergency care as well as senior services, orthopedics, surgical services and more. Learn more atwww.cvmc.com.

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

Why Prime Healthcare? (https://cvmc.com/careers/why-prime-healthcare/) Chino Valley 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.

Chino Valley 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

+ 401K retirement plan

+ Outstanding Medical

+ Dental

+ Vision Coverage

+ Tuition Reimbursement

+ Many more Voluntary Benefit Options! (https://www.primehealthcare.com/careers/benefits/)

Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time.

Chino Valley Medical Center is nationally recognized, locally preferred, and community focused.

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

Responsibilities

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.

Qualifications

Education and Work Experience

+ Bachelor's degree or four years of relevant experience required.

+ Accurate alphabetic, numeric, and/or terminal-digit filing skills.

+ Computer data entry with 10-key, with accurate typing speed of 35 wpm required. Excel skills highly preferred.

+ Knowledge of terminal digit filing and medical terminology; preferred.

+ Knowledge of State and Federal regulatory requirements for medical staff documentation; preferred.

+ Completion of a medical terminology course; preferred.

+ Background in business and office training; preferred.

Chino Valley 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 $23.15 to $30.03. 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.

Connect With Us! (https://careers-primehealthcare.icims.com/jobs/206765/utilization-tech-iii---utilization-management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306)

FacilityChino Valley Medical Center

LocationUS-CA-Chino

ID2025-206765

CategoryBusiness Professional

Position TypeFull Time

ShiftDays

Job TypeNon-Exempt