Scripps Health Administrative Services supports our five hospitals and 19 outpatient facilities, which treat half a million patients annually through 2,600 affiliated physicians.

At Scripps Health, you will experience the pride, support, and respect of an organization that has been repeatedly recognized as one of the nation’s Top 100 Places to Work.

You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.

Join a connected team at Scripps Health, working on our Case Management team. In the role of an AR II - Utilization Review, you will have the following responsibilities, amongst others:

• Responsible for working assigned queues, including making review determinations for referrals/authorizations on internal criteria list level.
• Responsible for preparation of authorization requests for internal RN review or external Health Plan review including obtaining appropriate medical records, Health Plan/Milliman criteria, benefit coverage information and forwarding to the appropriate reviewer. Enter review decisions in IDX.
• Act as a resource for referral/authorization questions from Health Plans and clinic staff.

This is a benefitted Full Time, Day Shift position primarily with a Monday - Friday hybrid (remote and onsite) schedule from 8AM - 4:30PM. Flexible schedule availability is a must as occasional weekend and alternative hours are needed.

Required Qualifications: Minimum of 3 years experience in a managed care setting preferably in utilization review. Working knowledge of Word, EXCEL, and Internet. Familiarity with medical terminology and coding required. Strong organizational skills. High level of independence and problem solving skills.

Preferred Qualifications: High School Diploma. College or vocational class completion in medical terminology and coding classes preferred. Minimum of 1 year experience with the IDX system preferred.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.