Coord -Utilization Review – CHMC Data Quality

Centinela Hospital Medical Center
October 17, 2020
Inglewood, CA
Job Type





Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings. Serves as on-going educator to all departments. Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. Performs other duties as assigned.


Education and Work Experience

    Required qualifications:

  1. Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.

Preferred qualifications:

  1. ECFMG Certification And/or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
  2. Utilization Review experience is highly preferred.
  3. Must meet the performance standards set forth by the Hospital/ Department at UR Coordinator position for at least 6 months.
  4. 1+ year of clinical experience in acute care setting preferred.
  5. Excellent written and verbal communication skills. Excellent critical thinking skills.

Benefits include

  • Medical, Dental & Vision Insurance
  • Life Insurance
  • Long Term Disability
  • Paid Time Off
  • 401(K) Retirement Participation  
  • Flexible Spending Accounts
  • Employee Assistance Plan
  • Tuition Reimbursement and much more.

We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.  EEO is the Law:

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