Utilization Review Coordinator

Prime Healthcare•Chula Vista, CA

2d•Onsite

About The Position

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Paradise Valley Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Paradise Valley Hospital is the South Bay’s oldest hospital, the second oldest hospital in all of San Diego County, and the largest employer in National City. For more than 100 years, Paradise Valley Hospital has served San Diego faithfully, proud of our heritage and providing numerous programs and services to meet the changing needs of our community. Our 291-bed, acute care hospital features the San Diego Spine & Joint Center, a highly credentialed acute rehabilitation center, our Paradise Health & Senior Center, a fully equipped and modern cardiac catheterization lab, and comprehensive inpatient and outpatient surgical services, and 24-hour emergency services. In addition to our healthcare services, we offer comprehensive behavioral health services on the hospital campus and Bayview campus in Chula Vista. Services include psychiatric continuum of care for adult patients, inpatient services, and intensive outpatient services. Learn more at https://www.paradisevalleyhospital.net/.

Requirements

Bachelors degree in Medicine or Nursing or related Clinical field.

Nice To Haves

ECFMG Certification And/or Bachelors or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
Utilization Review experience is highly preferred.
Must meet the performance standards set forth by the Hospital/ Department at UR Coordinator position for at least 6 months.
1+ year of clinical experience in acute care setting preferred.
Excellent written and verbal communication skills.
Excellent critical thinking skills.

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.
Responsible for reviewing patient charts in order to assess whether the 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.