Medical Review Coordinator - Social Work Services

St. Mary's General Hospital•Passaic, NJ

About The Position

The Medical Review Coordinator coordinates and completes clinical reviews of patient medical records, working closely with the Chief Medical Officer (CMO). 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 records requests from payers and fiscal intermediaries; 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 applicable federal, state, and intermediary guidelines for inpatient acute care and lower levels of care. The position also coordinates discharge referrals requested by clinical staff, fiscal intermediaries, patients, and families, and performs other assigned duties.

Requirements

A Master of Public Health (MPH) or postgraduate education in a related health care field is required.
Medical graduate or dental graduate qualification is required.
Knowledge of clinical pathophysiology and pharmacology is required.

Nice To Haves

ECFMG certification and/or a bachelor's degree or higher from a US-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.
Excellent written and verbal communication skills and 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.
Computer data entry with 10-key; accurate typing speed of 35 words per minute.

Responsibilities

Coordinate and complete clinical reviews of patient medical records in collaboration 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 continued treatment are met.
Gather data and respond to records requests from payers and fiscal intermediaries.
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 hospitalization and lower levels of care.
Coordinate discharge referrals requested by clinical staff, fiscal intermediaries, patients, and families.
Perform other duties as assigned.