Medical Review Coordinator
About The Position
The Medical Review Coordinator works in the Utilization Management department at Resurrection Medical Center. The role coordinates and reviews medical records assigned to a caseload, assesses whether patient admission and continued-treatment criteria are met, and gathers and communicates clinical and fiscal information for utilization review and case management reporting. The coordinator responds to payer and fiscal-intermediary requests for records, participates in Case Management and Treatment Team meetings, and provides ongoing education to hospital departments. The position also coordinates discharge referrals when requested by clinical staff, fiscal intermediaries, patients, or families, and performs other duties as assigned.
Requirements
- Medical, dental, physician assistant, or nursing graduate.
- Knowledge of federal, state, and intermediary guidelines related to inpatient acute-care hospitalization and lower levels of care for continuity of treatment.
- Ability to work independently and use sound judgment.
- Ability to work independently in a time-oriented environment.
- Excellent written and verbal communication skills.
- Excellent critical-thinking skills.
- Excellent interpersonal skills to build effective partnering relationships with physicians, nursing staff, coding staff, and hospital management staff.
Nice To Haves
- ECFMG certification and/or a bachelor's degree or higher from a U.S.-based accredited institution in a Health and Human Services field.
- Utilization Review experience.
- Clinical experience in an acute-care setting.
Responsibilities
- Coordinate and review assigned medical records.
- Review patient charts to assess whether admission and continuation-of-treatment criteria are met.
- Gather data and respond to requests for records from payers, fiscal intermediaries, and others.
- Gather clinical and fiscal information and communicate the status of open and closed accounts for Utilization Review and Case Management reporting.
- Participate in Case Management and Treatment Team meetings.
- Serve as an ongoing educator to hospital departments.
- Coordinate discharge referrals as requested by clinical staff, fiscal intermediaries, patients, and families.
- Perform other duties as assigned.
Benefits
- Paid time off
- 401K retirement plan
- Medical coverage
- Dental coverage
- Vision coverage
- Tuition reimbursement
- Voluntary benefit options
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
