Medical Review Coordinator

Prime Healthcare•Kankakee, IL

10h•Onsite

About The Position

This role coordinates and reviews all assigned medical records, actively participates in Case Management and Treatment Team meetings, and serves as an ongoing educator to all departments. The Medical Review Coordinator is responsible for reviewing patient charts to assess admission and continuation of treatment criteria, gathering data and responding to requests for records from payers/fiscal intermediaries, and communicating the status of accounts for various reporting levels. The position requires knowledge of Federal, State, and intermediary guidelines related to inpatient and acute care hospitalization, as well as lower levels of care for treatment continuity. Additionally, the role coordinates discharge referrals and performs other assigned duties.

Requirements

Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.
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.
Able to work independently and use sound judgment.

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 experience is highly 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.

Responsibilities

Coordinates and reviews all medical records, as assigned to caseload.
Actively participates in Case Management and Treatment Team meetings.
Serves as on-going educator to all departments.
Reviews patient charts to assess whether the criteria for admission and continuation of treatment is being met.
Gathers data and responds to request for records from payers/fiscal intermediary etc.
Gathers clinical and fiscal information and communicates status of both 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.