Medical Review Coordinator I

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.
• Reviews patient charts to assess criteria for admission and continuation of treatment; gathers data and responds to requests for records; gathers clinical and fiscal information and communicates account status.
• Works independently and uses sound judgment.
• Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, and lower levels of care for the continuity of treatment.
• Captures discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families.
• Performs other duties as assigned.

  Qualifications

  • Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.
  • Educational background: ECFMG Certification and/or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
  • Experience: Utilization Review experience is highly preferred. Clinical experience in acute care setting preferred.
  • Skills: 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.
  • Other: Ability to work independently in a time-oriented environment.

    Pay

    A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $32.00 to $46.35. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Benefits

    The company offers a comprehensive benefits package that includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Learn more about our benefits here: https://www.primehealthcare.com/benefitsthatmattermost/.