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Utilization Review Coordinator1 PT21

Primary Location Moreno Valley, California Facility Name Moreno Valley Medical Center Schedule Part-time Shift Day Salary $30.81 - $39.82 / hour

Job Number 1402694 Date Posted 03/31/2026

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Job Summary:

Conducts reviews of medical records and treatment plans to evaluate and consult on necessity, appropriateness, and efficiency of health care services, under direct supervision. Communicates with physicians, managers, staff, members and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care regarding requirements related to medical necessity and benefit denials across the continuum of care, under direct supervision. Observes and escalates utilization trends learns about addressing deficiencies in utilization review workflow/processes to ensure compliant and cost-effective care. Supports education and compliance initiatives by remaining up-to-date on the relevant regulations and guidelines, and participating in education and training programs for staff and physicians to promote best practices in utilization management.

Essential Responsibilities:

Pursues effective relationships with others by sharing information with coworkers and members. Listens to and addresses performance feedback. Pursues self-development; acknowledges strengths and weaknesses, and takes action. Adapts to and learns from change, challenges, and feedback. Responds to the needs of others to support a business outcome.

Completes routine work assignments by following procedures and policies and using data, and resources with oversight and management. Collaborates with others to address business problems; escalates issues or risks as appropriate; communicates progress and information. Adheres to established priorities, deadlines, and expectations. Identifies and speaks up for improvement opportunities.

Supports high-quality consultation by: communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care, under direct supervision; and leveraging working knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.

Supports education and compliance initiatives by: remaining up-to-date and discussing with the team the relevant state and federal regulations, guidelines, criteria, and documentation requirements that affect utilization management; and participating in education and training programs for staff and physicians at the local level to promote best practices in utilization management.

Assists in quality improvement efforts by: observing and escalating utilization patterns, trends, and opportunities for improvement; learning about utilization review workflows/processes including corrective action plans and standard work, and identifying deficiencies in workflows; and learning and actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care.

Performs utilization reviews by: following standard policies and procedures when conducting reviews of medical records and treatment plans to evaluate the medical necessity, appropriateness, and efficiency of requested health care services, under direct supervision; and beginning to assess the ongoing need for services, identifying potential issues/delays, and recommending appropriate actions for standard member cases.

Knowledge, Skills and Abilities: (Core)

Ambiguity/Uncertainty Management
Attention to Detail
Business Knowledge
Communication
Critical Thinking
Cross-Group Collaboration
Decision Making
Dependability
Diversity, Equity, and Inclusion Support
Drives Results
Facilitation Skills
Health Care Industry
Influencing Others
Integrity
Learning Agility
Organizational Savvy
Problem Solving
Short- and Long-term Learning & Recall
Teamwork
Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

Acts with Compassion
Confidentiality
Consulting
Evidence-Based Medicine Principles
Quality Assurance and Effectiveness
Relationship Building
Written Communication

Minimum Qualifications:

High School Diploma or GED, or equivalent.

Preferred Qualifications:

Primary Location: California,Moreno Valley,Moreno Valley Medical Center Scheduled Weekly Hours: 21 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: 07:30 AM Working Hours End: 01:30 PM Job Schedule: Part-time Job Type: Standard Worker Location: Onsite Employee Status: Regular Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee Job Level: Individual Contributor Department: Moreno Valley Hospital - Utilization Management - 0801 Pay Range: $30.81 - $39.82 / hour Kaiser Permanente is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills and geographic location along with a review of current employees in similar roles to ensure that pay equity is achieved and maintained across Kaiser Permanente. Travel: No On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.

Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.

Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.

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Expected Employee Conduct >