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KPC Health

Utilization Review Tech

Santa Ana, CA · On-site

Utilization Review Technician Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being ...

Global Force

Utilization Review Nurse

Las Vegas, NV · On-site

Reviews patient admissions for appropriateness, efficiency of resource utilization and compliance with third party payer requirements. Duties include analyzing medical charts, determining whether ...

Lifepoint Health

Specialist, Utilization Review

Holyoke, MA · On-site

$33.22 - $44.85/hr

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued stays. UR analyzes patient records to determine legitimacy of admission, treatment, and length of ...

Silver Cross Hospital

Utilization Review Nurse

New Lenox, IL · On-site

$34.73 - $45.15/hr

Performs medical record review for severity of illness and intensity of service; liaison function with external review agencies to ensure compliance with regulations affecting financial reimbursement ...

Shannon Health

Utilization Review Nurse

Big Spring, TX · On-site

Job Summary The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the ...

Collabera

Document Review Attorney

Eagan, MN · On-site

Document Review Attorney Location: Eagan, MN Duration: 4 month (may extend) Responsibilities: Using legal skills to review, analyze and abstract a wide range of contracts including Patent License ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

Coordinates the utilization management functions of a patient caseload through collaboration with the interdisciplinary treatment team and performance of reviews, with external review organizations ...

iPlace USA

Concurrent Review Nurse

Bedford, NH · On-site

Perform onsite review of emergent/urgent and continued stay requests Qualifications * 2+ years of clinical nursing experience in an acute care. * Current state's RN license. Additional Information ...

iPlace USA

Concurrent Review Nurse

Bedford, NH · On-site

Perform onsite review of emergent/urgent and continued stay requests Qualifications * 2+ years of clinical nursing experience in an acute care. * Current state's RN license. Additional Information ...

UHS

Utilization Review Coordinator

West Columbia, SC · On-site

Knowledge of external review organizations, payor sources, financial planning and contracting (i.e., managed care, Medicare, Medicaid, etc.) * Must be able to work in a fast-paced environment with ...

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Review information

What is a review?

A 'Review' job typically involves evaluating products, services, or content to provide feedback, ratings, and recommendations. People in review roles may write detailed reports, create video or written reviews, and help consumers or organizations make informed decisions. These jobs often require strong analytical skills, attention to detail, and clear communication abilities. Reviewers may work independently, as part of a media outlet, or for companies seeking quality assurance.

What are the key skills and qualifications needed to thrive as a review analyst, and why are they important?

To thrive as a Review Analyst, you need strong analytical abilities, attention to detail, and a background in data analysis or a related field. Familiarity with data management tools, spreadsheets, and review platforms such as Tableau or Microsoft Excel is often required. Critical thinking, effective communication, and the ability to work independently are standout soft skills for this role. These competencies ensure that data and content are accurately evaluated and actionable insights are delivered to support business decisions.

What are some common challenges faced by professionals in review roles and how can they be overcome?

Professionals in review roles often encounter challenges such as tight deadlines, handling large volumes of information, and maintaining objectivity and accuracy under pressure. To overcome these obstacles, it helps to develop strong organizational and time-management skills, utilize checklists or review protocols, and regularly communicate with team members to clarify expectations or address ambiguities. Leveraging technology and collaboration tools can also streamline workflows, ensuring that high-quality reviews are delivered efficiently.

What is the difference between Review vs Quality Assurance Specialist?

AspectReviewQuality Assurance Specialist
Primary RoleEvaluate and provide feedback on content, products, or servicesDevelop and implement testing processes to ensure product quality
Required SkillsAttention to detail, communication, analytical skillsTesting techniques, problem-solving, process improvement
Work EnvironmentOffice, remote, or client sitesOffice, lab, or production environments
CertificationsNot always required, but certifications like Content Review or Editing may helpQuality assurance certifications such as ASQ CQE or ISTQB

While both roles focus on quality, a Review primarily assesses content or products for accuracy and clarity, providing feedback for improvement. A Quality Assurance Specialist develops testing protocols and ensures products meet quality standards through systematic testing. Understanding these differences helps job seekers identify the right career path or job opportunity in quality-related fields.

More about Review jobs

What cities are hiring for Review jobs?

Cities with the most Review job openings:

What are the most commonly searched types of Review jobs?

The most popular types of Review jobs are:

What states have the most Review jobs?

States with the most job openings for Review jobs include:

Review jobs near you
Infographic showing various Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Utilization Review Tech

KPC Health

Santa Ana, CA • On-site

Other

Posted 17 days ago

Job description

Utilization Review Technician

Under direction of the Utilization Review Technician Supervisor, the Utilization Review Technician coordinates with the Utilization Management Department while being responsible for coordinating phone calls, clinical requests, upkeeps data entry, organizes denials and mailing/faxing appeals, tracking data from various insurance providers and health plans regarding authorization and/or denials, expedite reviews and documentation to insurance providers. Monitors patient charts and records to provide to responsible parties and request for authorization for hospital admission. Reviews treatment plans and status of approvals from insurers. Collects and compiles data as required and according to applicable policies and regulations. Performs administrative duties for the Utilization Management Department, and directed in several aspects of duties. Position is non-RN/LVN.

Requirements
  • Ability to establish and maintain effective working relationships across the Health System
  • Ability to interpret and understand various medical insurance plans and make accurate determinations regarding coverage
  • Follow up with insurance companies regarding the status of outstanding claims and necessary steps for resolution
  • Answer and review pertinent insurance correspondence to ensure complete and accurate reimbursement for medical claims
  • Responsible for working payer correspondence, edits and aged account receivable, and identifying and correcting billing errors
  • Pull daily reports utilizing Microsoft Excel and providing correct correspondence to payer
  • Research payer rules and regulations to maintain current payer knowledge
  • Comply with HIPAA and other compliance requirements to protect patient confidentiality
  • Manage data in internal and external databases with accuracy
  • Provide high-level administrative support and assistance to the Director and Supervisor or other assigned leadership staff
  • Perform clerical and administrative tasks including drafting letters, memos, invoices, reports, and other documents for senior staff
  • Prepare patient charts for medical audits
Education & Experience Requirements:
  • High School Diploma
  • Healthcare experience strongly preferred
Skills & Abilities Requirements:
  • Excellent verbal and written communication skills
  • Excellent organizational skills and attention to detail
  • Excellent time management skills with a proven ability to meet deadlines
  • Ability to function well in a high-paced and at times stressful environment
  • Extensive knowledge of office administration, clerical procedures, and recordkeeping systems
  • Able to type minimum of 50 words per minute
  • Knowledge of CMS, State Regulations, URAC and NCQA guidelines preferred.
  • ICD-10 and CPT coding experience a plus
  • Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus
  • Extremely proficient with Microsoft Office Suite or similar software with the ability to learn new or updated software
  • Medical Terminology preferred
Physical Requirements:
  • Body Positions: Sitting and standing for prolonged periods.
  • Body Movements: Arm and hand dexterity.
  • Body Senses: Must have command of close and distant sight, color perception and hearing.
  • Strength: Ability to lift and move up to 25-pounds.
Working Environment:
  • Work in an office, where the climate is controlled.
  • OSHA exposure category: II
  • Category I – Position includes tasks that involve exposure to Blood borne Pathogens.
  • Category II – Position includes tasks that do not have exposure to Bloodborne Pathogens, however employment may require unplanned Category I tasks.
  • Category III – Positions includes tasks that do not involve exposure to Bloodborne Pathogens. This position would not be required to perform Category I tasks.
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About KPC Health

Sourced by ZipRecruiter

KPC Health has an integrated approach to serving the people of Riverside, San Bernardino and Orange County. Our acute care medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcare is not just about caring for our patients, but also about investing in the people throughout our communities. We are one team with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health.

Industry

Health care and social assistance

Company size

201 - 500 Employees

Headquarters location

Santa Ana, CA, US

Year founded

2004

Social media

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