Medical Review Coordinator
About The Position
The Medical Review Coordinator works in Utilization Management at Resurrection Medical Center. The coordinator reviews medical records assigned to their caseload, assessing whether criteria for admission and continued treatment are met. The role involves collecting clinical and fiscal information, responding to payer and fiscal intermediary requests for records, and communicating the status of open and closed accounts for Utilization Review and Case Management reporting. The coordinator applies knowledge of applicable federal, state, and intermediary guidelines for inpatient acute care and lower levels of care to support continuity of treatment. The coordinator participates in Case Management and Treatment Team meetings, provides ongoing education to departments, and coordinates discharge referrals when requested by clinical staff, fiscal intermediaries, patients, or families. The role requires independent work and sound judgment, as well as other duties as assigned.
Requirements
- Medical, dental, physician assistant, or nursing graduate.
- Excellent written and verbal communication skills.
- Excellent critical-thinking skills.
- Excellent interpersonal skills to build effective partnerships 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 degree or higher from a US-based accredited institution in a Health and Human Services field.
- Utilization Review experience.
- Clinical experience in an acute care setting.
Responsibilities
- Coordinate and review medical records assigned to the caseload.
- Participate in Case Management and Treatment Team meetings.
- Provide ongoing education to all departments.
- Review patient charts to assess whether admission and continued-treatment criteria are met.
- Gather data and respond to payer and fiscal intermediary requests for records.
- Gather clinical and fiscal information and communicate the status of open and closed accounts for Utilization Review and Case Management reporting.
- Apply federal, state, and intermediary guidelines related to inpatient acute care and lower levels of care to support continuity of treatment.
- Coordinate discharge referrals as requested by clinical staff, fiscal intermediaries, patients, and families.
- Work independently and exercise sound judgment.
- Perform other duties as assigned.
Benefits
- Paid time off
- 401(k) retirement plan
- Medical coverage
- Dental coverage
- Vision coverage
- Tuition reimbursement
- Additional voluntary benefit options
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
