Clinical Review & Case Management Coordinator

Prime Healthcare; Las Vegas, Northern (NV, KY); Hybrid; USD 80,000 - 105,000; Full time

Job summary

North Vista Hospital, a Prime Healthcare facility in North Las Vegas, seeks a qualified Utilization Review/Case Management professional to join its award-winning team. The role focuses on clinical review of patient records, coordinating with the Chief Medical Officer, and supporting admission decisions and discharge planning.

Required MPH or related healthcare degree, medical graduate credentials, and knowledge of clinical pathophysiology and pharmacology; experience in case management and UR is

Qualifications

• MPH or related health care field is required.
• Medical graduate credentials are required.
• Knowledge of Clinical Pathophysiology and Pharmacology is required.
• ECFMG certification or US-based degree is highly preferred.

Responsibilities

• Review patient charts to assess criteria for admission and continuation of treatment.
• Coordinate data and respond to payer/fiscal intermediary requests.
• Attend UR and Case Management meetings; educate departments.
• Communicate status of open/closed accounts for Utilization Review reporting.
• Coordinate discharge referrals with clinical staff and families.

Skills

Critical thinking

Communication skills

Interpersonal skills

Independent work

Time management

Documentation accuracy

Education

MPH or related healthcare field

Medical Graduate

ECFMG certification / US-education

Tools

10-key data entry

Computer literacy

Job description

North Vista Hospital, a Prime Healthcare facility in North Las Vegas, seeks a qualified Utilization Review/Case Management professional to join its award-winning team. The role focuses on clinical review of patient records, coordinating with the Chief Medical Officer, and supporting admission decisions and discharge planning.

Required MPH or related healthcare degree, medical graduate credentials, and knowledge of clinical pathophysiology and pharmacology; experience in case management and UR is