Medical Review Coordinator - Utilization Review

Dallas Regional Medical Center • Mesquite, TX

67d

About The Position

The Medical Review Coordinator coordinates and completes clinical reviews of patient medical records while working closely with the Chief Medical Officer. The role participates in Case Management and Utilization Review meetings and provides ongoing education to hospital departments. It reviews patient charts to determine whether clinical criteria for admission and continued treatment are met; gathers data and responds to payer and fiscal intermediary requests for records; and gathers clinical and fiscal information to communicate the status of open and closed accounts for Utilization Review and Case Management reporting. The coordinator works independently, applies sound judgment, and uses knowledge of federal, state, and intermediary guidelines for inpatient acute care and lower levels of care to support continuity of treatment. The role also coordinates discharge referrals requested by clinical staff, fiscal intermediaries, patients, and families, and performs other duties as assigned.

Requirements

• Master of Public Health (MPH) or post-graduate education in a related health care field.
• Medical graduate and dental graduate credentials are required.
• Knowledge of clinical pathophysiology and pharmacology.
• Excellent written and verbal communication skills.
• Excellent critical-thinking skills.
• Interpersonal skills to build effective working relationships with physicians, nursing staff, coding staff, and hospital management staff.
• Ability to work independently in a time-oriented environment.

Nice To Haves

• ECFMG certification and/or a bachelor's or higher degree from a U.S.-based accredited institution in a Health and Human Services field.
• Utilization Review or Case Management experience.
• At least one year of clinical experience in an acute care setting.
• Computer data entry with 10-key skills.
• Accurate typing speed of 35 words per minute.

Responsibilities

• Coordinate and complete clinical reviews of patient medical records while working closely with the Chief Medical Officer.
• Participate in Case Management and Utilization Review meetings.
• Provide ongoing education to hospital departments.
• Review patient charts to assess whether clinical criteria for admission and continuation of treatment are met.
• Gather data and respond to requests for records from payers, fiscal intermediaries, and others.
• Gather clinical and fiscal information and communicate open- and closed-account status for Utilization Review and Case Management reporting.
• Apply federal, state, and intermediary guidelines related to inpatient acute care hospitalization and lower levels of care for continuity of treatment.
• Coordinate discharge referrals as requested by clinical staff, fiscal intermediaries, patients, and families.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time