Utilization Review Coordinator - Utilization Management

Prime Healthcare•San Dimas, CA

63d•$25 - $39

About The Position

San Dimas Community Hospital is a 101 bed facility located on a 13-acre campus in the heart of San Dimas. With a multidisciplinary team of experts and state of the art technology, we are committed to serving the community with personalized, high-quality care. We offer a full range of comprehensive services, including 24-hour emergency services, a family birth center, orthopedic surgery, advanced diagnostic services, cardiopulmonary and gastrointestinal services. San Dimas Community Hospital has received multiple awards including the "100 Top Hospitals," Women's Choice Award for America's Best Hospitals for Patient Safety, and Healthgrades awards, including the "Patient Safety Excellence Award." Learn more at sandimashospital.com . Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community ! Why Prime Healthcare? San Dimas Community Hospital , a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. San Dimas Community Hospital offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to: Paid time off 401K retirement plan Outstanding Medical Dental Vision coverage Tuition reimbursement Many more voluntary benefit options! Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time. This is a Fast-paced work environment in which you can take pride in serving an underserved community. Come Join a Team of Dedicated Healthcare Workers!!! San Dimas Community Hospital is nationally recognized, locally preferred, and community focused.

Requirements

Bachelor's degree in Medicine or Nursing or related Clinical field.
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.

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.

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.