Medical Review Coordinator
About The Position
At Centinela Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, Centinela Hospital Medical Center is actively seeking new members to join its award-winning team! Centinela Hospital Medical Center has been serving the communities of Inglewood and the wider Los Angeles area for 100 years. An award-winning facility, ranking in the top 5% nationally for quality and patient safety, Centinela Hospital is a 362-bed acute-care hospital with a 24-hour STEMI certified emergency department and primary stroke center, orthopedic care, advanced cardiac services, critical care services, inpatient and outpatient rehab programs, and more. Centinela has earned hundreds of national awards and recognitions, including "100 Top Hospital" recognition from Fortune/Merative and straight 'A's (2018-2024) for hospital safety from The Leapfrog Group. For more information, visit www.centinelamed.com.
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.
Benefits
- paid time off
- a 401K retirement plan
- medical, dental, and vision coverage
- tuition reimbursement
- many more voluntary benefit options
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
