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Chart Utilization Review Jobs in California (NOW HIRING)

During chart review, is aware of criteria for quality variances. Complies with Kaweah Health Policy by reporting utilization variances to Case Management Committee and/or the P.I. department as ...

During chart review, is aware of criteria for quality variances. Complies with Kaweah Health Policy by reporting utilization variances to Case Management Committee and/or the P.I. department as ...

Chart Auditor - Glendale

Glendale, CA · On-site

$62.83 - $86.18/hr

Adventist Health Glendale is looking for Chart Auditor for Full-time, Day Shift. We are looking for ... Prior experience in utilization review, case management, coding, or clinical auditing: Preferred ...

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Chart Utilization Review information

What are the key skills and qualifications needed to thrive as a Chart Utilization Review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is Chart Utilization Review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in Chart Utilization Review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

What cities in California are hiring for Chart Utilization Review jobs? Cities in California with the most Chart Utilization Review job openings:
Infographic showing various Chart Utilization Review job openings in California as of July 2026, with employment types broken down into 2% As Needed, 81% Full Time, 15% Part Time, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Utilization Review Quality Improvement Specialist-26431407

County of San Diego

San Diego, CA

$114K - $140K/yr

Other

Posted 9 days ago


County Of San Luis Obispo rating

7.6

Company rating: 7.6 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

506th of 836 rated public administrative organizations


Job description

Job Summary Behavioral Health Services (BHS) is currently accepting applications for the position of Utilization Review Quality Improvement Specialist (RN, LCSW, LMFT, LPCC, Clinical Psych) Interviews will take place the week of September 8, 2026. Job offers for selected candidates will be made the week of September 14, 2026. The starting salary for this position will be based on the candidate's qualifications at time of appointment.

Future Salary Increases ** June 2027 - 4.73% increase to base pay (3.0% Across-the- Board +1.73% Market Adjustment) Utilization Review Quality Improvement Specialists chart and interpret medical records for utilization review and reviews medical records for medical necessity and Medi-Cal compliance in County operated inpatient, outpatient, day treatment, and contracted facilities. The current vacancy is in Behavioral Health Services Administration located at 3255 Camino del Rio South, San Diego; however, the list established from this recruitment may be used to fill future vacancies in other departments. The Utilization Review Quality Improvement Specialist position has three options where focus is on either the quality management of mental health programs OR substance use disorders (SUD) programs OR Network Quality and Planning Team

Read the Utilization Review Quality Improvement Specialist job description, including minimum qualifications and essential functions. ***Effective September 9, 2022, this hard to recruit position qualifies for the Employee Referral Reward Program. If a current County of San Diego employee referred you to apply for this position, please indicate the employee's name on your job application in the space provided.

*** Hiring Process and Timeline Job Offer and Background Process begins after week of September 14, 2026.. Note: Current County employees may be excluded from additional background screening. Pre-employment Medical Screening: Approximately 3 days following successful background investigation results

Anticipated Start Date: Start date will be based upon successful completion of medical screening or other mutually agreed upon date. If you are not selected for this interview process, you may have the opportunity to compete for future vacancies Minimum Qualifications Required Education and Experience: Current valid California license as a Registered Nurse, Licensed Clinical Social Worker, Licensed Marriage Family Therapist, Licensed Professional Clinical Counselor, or Licensed Clinical Psychologist is required at time of application and must be maintained throughout employment; AND, One (1) year of recent, licensed clinical experience in an acute care psychiatric hospital or outpatient facility performing the duties of a Registered Nurse, Licensed Clinical Social Worker, Licensed Marriage Family Therapist, Licensed Professional Clinical Counselor, Licensed Clinical Psychologist, or related profession where duties included charting and interpreting medical records for the purpose of utilization review. Note: Quality improvement, utilization review, peer review, or other chart review experience is highly desirable.

The ideal candidate will: Have knowledge and experience in electronic health records and training Possess strong clinical and analytical skills, be detail oriented, and have excellent customer service skills Work well independently and within a team, and speak in front of groups Have the ability to analyze complex information and problems, and the ability to apply critical thinking to solve complex problems. Have knowledge of federal and state regulations regarding the delivery of mental health, and alcohol and drug services to the County of San Diego Behavioral Health System of Care. Have knowledge of quality improvement practices in order to implement quality improvement processes; ability to understand and interpret policies and procedures.

Be well organized and adaptive to fluctuating workload assignments and a positive attitude in their work style in order to accomplish the goals of the Quality Improvement Unit. Blind Applicant Screening The Department of Human Resources removes personally identifiable information from all recruitments. This practice, called Blind Applicant Screening, hides a candidate's personal information that could influence or bias a hiring decision.

Personal information includes name, phone number, address, gender, age and race. This process helps contribute to a fair and equitable selection process leading to a more diverse and inclusive workforce. The most highly qualified candidates, based on the evaluation results, will be referred for an interview.

Be sure to include your experience in meeting the minimum requirements in both the Work Experience section and the Supplemental Questionnaire section of the Application. Resumes will not be accepted in lieu of the application Work History and/or supplemental questionnaire. Condition of Employment As part of the County of San Diego's pre-employment process, prospective candidates will undergo a background check (including fingerprinting) and a pre-employment medical screening prior to beginning County employment.

Additional types of background investigations may be conducted based on the job-related activities of the position. Current County employees may be excluded from this process. Evaluation The names of qualified applicants will be placed on a six (6) month employment list based upon scores received during the evaluation of information contained in their employment application and supplemental application questionnaire.

Please ensure all information is complete and accurate, as the responses you provide on the supplemental application questionnaire will be reviewed using an automated evaluation system. If you are successful in the initial screening process, your application will be reviewed individually to confirm that the information you provided is accurate and qualifying. Accommodation Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the essential functions of a job, on a case-by-case basis.

As an employer of over 19,000 employees, the County of San Diego is an organization committed to veteran hiring, retention, and professional development. We recognize the contributions and sacrifices made by our veterans and value the unique expertise and leadership qualities they bring to our workforce. We strive to provide veterans with the resources and tools necessary to maximize their employment opportunities, and to assist veterans with their transition into civilian life by applying the valuable skills, knowledge and training acquired in service to positions and career paths at all levels within our large organization.

Click on the resource links below to learn more about how the County of San Diego supports its veterans. Veteran's Preference Policy The County of San Diego offers preferential credits for military service to assist qualified applicants in transitioning from military to civilian careers with the County of San Diego. Please read the Veteran's Preference Policy for additional information.

Military Skills Translator Do you need assistance translating your military experience into civilian experience. This tool can help. Please read the Military Skills Translator to access the tool.

Disaster Service Worker The County of San Diego and its employees embrace the vision of :a just, sustainable, and resilient future for all. Our values include: integrity, equity, access, belonging, excellence, and sustainability. Each of which are infused throughout our operations.

While also embracing a mission of strengthening our communities with innovative, inclusive, and data driven services through a skilled and supported workforce. Click here for more information on our Strategic Plan (sandiegocounty.gov)(Download PDF reader). Under California Government Code Sections 3100 - 3109, public employees are designated as disaster service workers

The term "public employees" includes all persons employed by the state or any county, city, state agency, or public district. Disaster service workers are required to participate in such disaster service activities as may be assigned to them by their employer or by law. The County of San Diego is committed to valuing diversity and practicing inclusion because our diverse workforce is our greatest asset and our customers are our number one priority.


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