Medical Review Coordinator I

Prime Healthcare Management Inc•Ontario, CA

8d•$33 - $46

About The Position

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 51 hospitals and has more than 360 outpatient locations in 14 states providing more than 2.5 million patient visits annually. It is one of the nation’s leading health systems with nearly 57,000 employees and physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings. Serves as on-going educator to all departments. Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. Performs other duties as assigned.

Requirements

Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.

Nice To Haves

ECFMG Certification And/or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
Utilization Review experience is highly preferred.
Clinical experience in acute care setting preferred.
Excellent written and verbal communication skills.
Excellent critical thinking skills.
Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.
Ability to work independently in a time-oriented environment

Responsibilities

Coordinates and reviews all medical records, as assigned to caseload.
Actively participates in Case Management and Treatment Team meetings.
Serves as on-going educator to all departments.
Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met
Gathering data and responding to request for records from payers/fiscal intermediary etc.
Gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting.
Able to work independently and use sound judgment.
Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.
Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
Performs other duties as assigned.