Clinical Review & Utilization Coordinator – Acute Care

Centinela Hospital Medical Center; North Las Vegas (NV); On-site; USD 90,000 - 120,000; Full time

Job summary

North Vista Hospital in North Las Vegas, NV, seeks a qualified professional for Utilization Review/Case Management. The role focuses on reviewing patient records, ensuring admission and treatment criteria are met, and coordinating discharge planning with clinical and financial teams.

The position requires MPH or related health field and clinical background, with preferred UR/CM experience and strong communication skills to collaborate with physicians, nurses, and payers.

Qualifications

• Master of Public Health (MPH) or related health care field is required.
• Medical Graduate, Dental Graduate required.
• Knowledge of Clinical Pathophysiology and Pharmacology required.
• ECFMG Certification And/or Bachelor’s or higher from a US-based accredited Health/HH S program highly preferred.
• Utilization Review/Case Management experience preferred.
• 1+ year of clinical experience in acute care setting preferred.
• Excellent written and verbal communication skills and critical thinking.
• Excellent interpersonal skills to build partnerships with physicians, nurses, coding staff and hospital management.
• Ability to work independently in a time-oriented environment.
• Typing speed of 35 wpm preferred.

Responsibilities

• Coordinates and completes the clinical reviews for all patient medical records, working with the Chief Medical Officer.
• Participates in Case Management and Utilization Review meetings.
• Acts as an ongoing educator to all departments.
• Reviews patient charts to assess admission/continuation criteria and gathers data for payers and records requests.
• Gathers clinical and fiscal information and communicates status of open and closed accounts for UR/CM reporting.
• Coordinates discharge referrals as requested by clinical staff, payers, and families.
• Performs other duties as assigned.

Job description

North Vista Hospital in North Las Vegas, NV, seeks a qualified professional for Utilization Review/Case Management. The role focuses on reviewing patient records, ensuring admission and treatment criteria are met, and coordinating discharge planning with clinical and financial teams.

The position requires MPH or related health field and clinical background, with preferred UR/CM experience and strong communication skills to collaborate with physicians, nurses, and payers.