Utilization Review Specialist

We are proud to serve as a trusted resource for our community, providing high-quality mental health care with compassion and integrity. Our Long Beach facility currently operates as a 79-bed adult voluntary acute inpatient program, offering private rooms and individualized treatment delivered by a multidisciplinary team. We are dedicated to best practices and person-centered care, supporting each patient's journey toward stability and recovery.

To promote continuity of care beyond inpatient treatment, we also offer Partial Hospitalization (PHP) and Intensive Outpatient (IOP) programs tailored to meet each individual's clinical needs. We are also actively expanding our services across Southern California, with our new San Bernardino campus expected to open in early 2026.

Location: On-Site in Long Beach, CA
Schedule: 8-hour shifts

Pay Range: $ hourly

Position Summary

Our Utilization Review department manages both outpatient and inpatient patients. We work with Medicare, Medicare HMO, Medi-Cal , commercial insurance, including Medicare recertifications and other insurance authorization requirements. This role reviews clinical documentation, medical necessity, communicating with insurance companies, and ensuring patients meet the appropriate level-of-care criteria. The UR team works closely with providers, case management, and the clinical team to coordinate care, address insurance requirements, and support the best possible patient outcomes.

This position requires strong clinical judgment, communication, organization, critical thinking, and time-management skills, as well as the ability to collaborate effectively with payers, providers, and the healthcare team.

Make a difference by providing quality care alongside us at Ocean View!

Key Responsibilities

• Extensive experience in insurance eligibility and benefits
• Maintain accurate patient and payer records
• Submit
  24-hour notification into LA County TAR Unit Database
• Complete and submit TAR forms accurately
• Print or upload patient medical records as required
• Track submissions to ensure Timely processing and Approval or denial status updates
• TAR Tracking & Compliance
• Monitor deadlines and ensure compliance with all timelines
• Maintain tracking logs for all initial and appeal TARs
• While primarily assigned to the inpatient unit, may berequiredto support the Structured Outpatient Services Program (IOP/PHP) based on census fluctuations and departmental needs

Minimum Qualifications

• High School Diploma or GED required
• ICD-10 Coding Knowledge or Certification
• Billing and Coding Knowledge or Certification
• Medical Records Knowledge or Certification
• Ability to interact and communicate verbally and in writing with seriously and persistently mentally ill Patients, other staff members, and the public.
• Ability to speak, read, and write legibly in English.
• Minimum of two (2) years of experience inbehavioralhealth, healthcare, orhospitalsettings.
• Strong teamwork and collaboration skills across disciplines and departments.
• Proficiency in the use of computers and standard keyboard functions for data entry and electronic documentation.
• Experience using Electronic Health Records (EHR) systems for documentation and coordination of care.

Preferred Qualifications

• Bachelors degree in health information management, healthcare administration, or related healthcare field.
• Excellent verbal and written communication as well as strong interpersonal and organizational skills required.
• Previous JCAHO experience preferred.
• Prior experience using Electronic Health Records (EHR) systems for documentation and coordination of care.
• Comprehensive medical, dental, and vision insurance for qualifying employees
• 401(k) retirement savings plan
• Supportive, team-oriented work environment
• Opportunities for professional growth, training, and advancement within the organization

Special Conditions

• Employment is contingent upon successful completion of Live Scan fingerprinting, background check clearance, and verification of required licenses, certifications, and education
• Satisfactory completion of professional reference checks
• Must be legally authorized to work in the United States;
  Ocean View does not provide visa sponsorship for certain roles unless otherwise specified
• Compliance with all applicable federal, state, and local regulations, including California Department of Health Care Services (DHCS), The Joint Commission, and HIPAA standards
• Compliance with all required health screenings and immunization sin accordance with regulatory guidelines and facility policy,…