Utilization Coordinator

Responsibilities

Join the Southwest Healthcare Team!

Creating Health and Harmony, Southwest Healthcare is a comprehensive network of care with convenient hospital and ambulatory care/outpatient locations here to serve the Southern California community. With over 6,000 passionate providers and healthcare employees, our shared goal is to provide convenient access to a wide range of healthcare services in a way that benefits you, your family, and the entire community.

Southwest Healthcare is comprised of five acute care hospitals and several non‑hospital access points, including:
Corona Regional Medical Center, Palmdale Regional Medical Center, Southwest Healthcare Rancho Springs Hospital, Southwest Healthcare Inland Valley Hospital and Temecula Valley Hospital, Temecula Valley Day Surgery, A+ Urgent Care Centers, and Riverside Medical Clinics. For more information on how to join our dynamic team please visit our website at

The Southwest Healthcare Regional office in Temecula, CA is seeking a Full‑Time Utilization Coordinator who will support the Centralized Utilization Review department and collaborate with staff across the Southern California Region. Duties include but are not limited to:

• Outreach to payers via phone or fax for authorization/denial outcomes.
• Accesses payer portals daily to retrieve authorizations/denials and records outcomes.
• Reconciles all payer correspondences and runs daily department reports, taking action if needed.
• Run daily department reports and take action if needed.
• Enter all denials received into Artiva, manage worklist, and facilitate peer to peer.
• Maintains Medi‑Cal TAR logs and audits, accesses Medi‑Cal portal to submit required documents.
• Retrieves and delivers messages from Utilization Review Dept phone review line at least 4 times per day.
• Answers telephone professionally and courteously.
• Performs other related duties as requested by the UM Manager.

Experience/Training/

Experience:

• High School Graduate or equivalent required.
• Two (2) years of administrative experience in a healthcare setting required. Utilization management, managed care, or related role preferred.

Certifications/Licenses:

• None

Other

Skills and Abilities:

• Demonstrates knowledge and ensures compliance with the Nurse Practice Act, The Joint Commission and Title 22 standards and guidelines.
• Demonstrates compliance with healthcare policies and procedures at all times.
• Demonstrates strong leadership, organization, communication and interpersonal skills.
• Demonstrates ability to relate to clinical personnel and medical staff, as well as ability to interact well with the public.
• Must have knowledge of PC and applications.
• Ability to demonstrate effective written and verbal communication skills.
• Computer skills desirable.
• Ability to respond to any communication required by telephone.

• Challenging and rewarding work environment.
• Competitive Compensation & Generous Paid Time Off.
• Excellent Medical, Dental, Vision and Prescription Drug Plans.
• 401(K) with company match and discounted stock plan.
• SoFi Student Loan Refinancing Program.
• Tuition, CEU, Certification, Licenses Reimbursement program.
• Career development opportunities within UHS and its 300+ Subsidiaries!
• More information is available on our Benefits Guest Website: UHS Guest Benefits

Southwest Healthcare is owned and operated by subsidiaries of Universal Health Services, Inc. (UHS), a King of Prussia, PA‑based company, one of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation. Headquartered in King of Prussia, PA, UHS has 99,000 employees.

Through its subsidiaries, UHS operates 28 acute care hospitals, 331 behavioral health facilities, 60 outpatient and other facilities in 39 U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries…