Utilization Review Coordinator Lead

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation's leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

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 Coordinator, Lead is responsible for the assisting with the implementation and ongoing management of the utilization review process for the self-insured Employee Health Plans, according to the EPO Plan Documents and any other applicable documents. The UR Coordinator, Lead will provide assistance in the direction and utilization of available resources to provide quality, cost effective care using selected benefits and alternative services best suited for the members while ensuring optimal outcomes. Through inter-professional collaboration with the Customer Service, Member and Provider Services Teams, the UR Coordinator, Lead will act as point-of-contact to provide guidance and resolution for complex member or provider calls that require escalation. The UR Coordinator, Lead will work closely with the Prime EHP, UR Director, UR Manager and UR Coordinators.

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1. High School Diploma or GED

2. Minimum of ten (10) years' experience in Utilization Review within a health plan and/or healthcare setting

3. Computer skills, Microsoft Office, proficiency in a variety of software programs

4. Excellent interpersonal relationship skills with exceptional professional work ethics

Preferred qualifications:

1. An active CA Licensed Vocational Nurse (LVN) License

2. Medical Terminology knowledge

Prime Healthcare 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 $24.00 to $33.91. 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.