Medical Review Coordinator I
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About The Position
The position involves coordinating and completing clinical reviews for all patient medical records while working closely with the Chief Medical Officer (CMO). The role requires active participation in Case Management and Utilization Review (UR) meetings and serves as an ongoing educator to all departments. Responsibilities include reviewing patient charts to assess whether clinical criteria for admission and continuation of treatment are met, gathering data, and responding to requests for records from payers and fiscal intermediaries. The position also involves gathering clinical and fiscal information and communicating the status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. The candidate must be able to work independently and use sound judgment, with knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for continuity of treatment. Additionally, the role includes coordinating discharge referrals as requested by clinical staff, fiscal intermediaries, patients, and families, and performing other duties as assigned.
