Medical Review Coordinator II - Social Work Services

Prime Healthcare•Passaic, NJ

1d•Onsite

About The Position

St. Mary's General Hospital, located in Passaic, NJ, is a community-based tertiary medical center focused on providing quality, compassionate care. It is an acute care hospital providing a broad range of services including cardiovascular services as well as a comprehensive program for cancer care. The hospital is also a center of excellence for maternal-child health and outpatient behavioral health services. It is the only hospital in Passaic and with over 550 physicians and 1,000 employees, and is one of the largest employers in the county. Every member of the St. Mary's General team is committed to providing respectful, personalized, high-quality care. St. Mary's General Hospital is a member of Prime Healthcare, which has been lauded as a "Top 15 Healthcare System" by Truven Health Analytics.

Requirements

Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.
Two years of Utilization Review experience as a Medical Review Coordinator – I required.
Knowledge of Clinical Pathophysiology and Pharmacology 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.
Master of Public Health (MPH) or post-graduation in a related health care field 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.
Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.

Responsibilities

Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief Medical Officer).
Actively participates in the Case management and UR meetings.
Serves as on-going educator to all departments.
Responsible for reviewing patient charts in order to assess whether the clinical 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.