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Chart Utilization Review Jobs in California (NOW HIRING)

Adventist Health

Chart Auditor - Glendale

Glendale, CA · On-site

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 ...

Adventist Health

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 ...

Dignity Health

RN - Case Manager

Carmichael, CA · On-site

... • Reviews & analyzes information relative to utilization management when applicable. • ... chart review and participation on clinical effectiveness teams. • Documents CM actions taken in ...

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Chart Utilization Review information

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 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 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 are popular job titles related to Chart Utilization Review jobs in California?

For Chart Utilization Review jobs in California, the most frequently searched job titles are:

What job categories do people searching Chart Utilization Review jobs in California look for?

The top searched job categories for Chart Utilization Review jobs in California are:

What cities in California are hiring for Chart Utilization Review jobs?

Cities in California with the most Chart Utilization Review job openings:

Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in California as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 12% Part Time, 4% Temporary, and 6% Contract. Highlights an 98% In-person, 1% Hybrid, and 1% Remote job distribution.

Chart Auditor - Glendale

Adventist Health

Glendale, CA • On-site

Full-time

Re-posted 6 days ago

Adventist Health rating

7.7

Company rating: 7.7 out of 10

Based on 246 frontline employees who took The Breakroom Quiz

166th of 898 rated healthcare providers

Job description

Adventist Health Glendale is looking for Chart Auditor for Full-time, Day Shift. We are looking for great individual who can work onsite to our location in Glendale, CA

Nestled between Burbank and Pasadena, Adventist Health Glendale is one of the area's leading healthcare providers. We are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive cardiology care and a vast scope of services located in the San Fernando Valley. We are committed to the development and empowerment of our nurses and have received Magnet designation from the American Nurses Credentialing Center. Glendale is known for its urban living, with easy access to dining, entertainment, shopping, amusement parks and outdoor recreation. Adventist Health Glendale is proud to be part of the thriving, diverse community since 1905.

Job Summary:

Supports the Revenue Management Department by auditing medical records and clinical documentation to ensure proper patient status placement, accurate coding, and defensible payer billing. Focuses on clinical denials, observation services, documentation gaps, and payer requirements for authorization and coverage. Collaborates with Case Management, Utilization Management, Coding, Medical Officer, and Physician Advisors to reduce clinical denials, improve documentation quality, and ensure compliance with regulatory and payer standards. Provides analytic reports and feedback to identify systemic trends and educational opportunities.

Job Requirements:

Education and Work Experience:

  • Associate's degree in Nursing or related clinical field: Required
  • Bachelor's Degree in Nursing (BSN) or Healthcare Administration: Preferred
  • Prior experience in utilization review, case management, coding, or clinical auditing: Preferred

Licenses/Certifications:

  • Current licensed RN in the state of practice (RN), medical provider (MD), or International Medical Graduate with valid credential: Required
  • Registered Nurse (RN) or Medical license MD (MD) or Foreign Medical Doctor (FMD): Required

Essential Functions:

  • Conducts concurrent audits of active cases to identify documentation and order issues in real time, preventing downstream denials. Applies InterQual or Milliman/MCG criteria to validate patient status decisions and payer medical necessity compliance.
  • Reviews medical records to validate patient placement (inpatient vs. observation) against payer criteria and physician orders. Audits clinical denials to determine root cause, trends, and opportunities for appeal, and recommends actionable prevention strategies. Performs charge audits and account reconciliations to ensure documentation is appropriate, compliant with regulations, and free of denial risk. Provides recommendations for charge corrections and technical assistance in staff training.
  • Identifies barriers to clean claims and timely payment; tracks and trends denials, escalating systemic issues to the Director/Manager. Tracks and trends payer clinical denials, observation hours, and placement errors; prepares reports for Revenue Management leadership. Provides feedback to Coding and CDI teams regarding documentation needed for coding accuracy and DRG assignment.
  • Partners with Case Management, Utilization Management, Medical Officer, and Physician Advisors to ensure accurate clinical documentation and timely status changes. Collaborates in payer escalations and appeal preparation by supplying clinical and documentation findings. Educates providers and staff on documentation, status order accuracy, and denial prevention strategies.
  • Monitors CMS, state, and commercial payer regulatory changes impacting clinical documentation, placement, and observation requirements; integrates updates into audit practices. Demonstrates reliability, responsiveness, and effective follow-up on matters requiring attention.
  • Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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