Medical Review Coordinator - Utilization Review

Prime Healthcare•Olympia Fields, IL

5d•Onsite

About The Position

The Medical Review Coordinator will be responsible for coordinating and completing clinical reviews for all patient medical records, working closely with the Chief Medical Officer (CMO). This role involves actively participating in Case Management and Utilization Review (UR) meetings and serving as an ongoing educator to all departments. The coordinator will review patient charts to assess if clinical criteria for admission and treatment continuation are met, gather data, and respond to requests for records from payers and fiscal intermediaries. Additionally, they will collect clinical and fiscal information, communicate the status of open and closed accounts for various UR and Case Management reporting levels, and coordinate discharge referrals as requested by clinical staff, fiscal intermediaries, patients, and families. The position requires the ability to work independently, use sound judgment, and possess knowledge of Federal, State, and intermediary guidelines related to inpatient care, acute care hospitalization, and lower levels of care for treatment continuity. Other duties as assigned.

Requirements

Master of Public Health (MPH) or post-graduation in a related health care field is required.
Medical Graduate, Dental Graduate 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.
Utilization Review/Case Management experience is highly preferred.
1+ year of 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.