Medical Review Coordinator II

Prime Healthcare•Evanston, IL

19h•Onsite

About The Position

This role is responsible for coordinating and completing clinical reviews for patient medical records, working closely with the Chief Medical Officer (CMO). The position involves active participation in Case Management and Utilization Review (UR) meetings, serving as an ongoing educator to all departments. Key duties include reviewing patient charts to assess if clinical criteria for admission and continuation of treatment are met, gathering data and responding to requests from payers, and collecting clinical and fiscal information to report on the status of accounts for various levels of Utilization Review and Case Management. The role requires independent work, sound judgment, and knowledge of federal, state, and intermediary guidelines related to inpatient care and lower levels of care for treatment continuity. Additionally, the position coordinates discharge referrals and performs other assigned duties.

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 clinical reviews for all patient medical records.
Works closely with the Chief Medical Officer (CMO).
Actively participates in Case Management and UR meetings.
Serves as an ongoing educator to all departments.
Reviews patient charts to assess clinical criteria for admission and continuation of treatment.
Gathers data and responds to requests for records from payers/fiscal intermediary.
Gathers clinical and fiscal information and communicates status of open and closed accounts for multiple levels of Utilization Review and Case Management reporting.
Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
Performs other duties as assigned.