Medical Review Coordinator - Utilization Review

Overview

Department: Utilization Review
Shift: Full-Time, On-Site
Facility: Olympia Fields Hospital
Location: Olympia Fields, Illinois 60461

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.

Qualifications

Required

• 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.

Preferred

• 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.

Pay & Benefits

Olympia Fields 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, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.

A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $32 to $46.35 on an hourly basis. 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.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/