• Job Description

  Req#: 197145

  Overview

  Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen 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

  Responsibilities

  Under supervision from the clinical care team, provides care coordination for patients as they move into and through the care continuum. Primary responsibilities include providing utilization review function for direct admit patients, patient requiring repatriation, patient in out-of-network setting and providing clinical information to Chief Medical Officers for final determination. Ensures accurate, timely processing of insurance verifications, patient registration, timely notification of payor to ensure maximum reimbursement, facilitating benefit coverage for continuum of care needs, ensuring the flow of information to continuum care providers, and maintaining a high level of confidentiality.

  Qualifications

  Required qualifications:

  1. Must have clinical and patient care experience. 2. Must possess excellent spelling and grammar skills. 3. Ability to manage and prioritize multiple activities in a fast-paced environment. 4. Works in the department as needed in designated areas. 5. Ability to handle stressful situations with physicians and ancillary departments. 6. Must be detail-oriented and have a high degree of organizational skills. 7. Must have experience working with computers and computer software/applications.

  Preferred qualifications:

  1. Associates degree or higher degree preferred. 2. Previous insurance background preferred.3. Previous experience with Insurance UR preferred.

  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 $26.40 to $39.06. 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.

• About the company

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