Clinical Utilization & Case Management Coordinator

Prime Healthcare; Lewiston (ME); On-site; USD 39,000 - 60,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

Central Maine Medical Center, part of Prime Healthcare Foundation, is seeking a utilization review/case management professional in Lewiston, ME to coordinate clinical reviews, participate in UR meetings, and educate departments on utilization processes.

Must have MPH or related health care degree and medical or dental graduate credentials. Strong knowledge of clinical pathophysiology and pharmacology is required; excellent communication and teamwork are essential.

Qualifications

• MPH or related health care degree required.
• Medical or dental graduate required.
• Knowledge of clinical pathophysiology and pharmacology required.

Responsibilities

• Coordinate and complete clinical reviews for patient medical records with CMO.
• Participate in Case Management and UR meetings.
• Educate departments on utilization review processes.
• Review patient charts to assess admission criteria and continuation of treatment.
• Gather data and respond to payer requests for records.
• Coordinate discharge referrals as requested by staff, intermediary, patients and families.
• Work independently with sound judgment.

Skills

Communication skills

Critical thinking

Interpersonal skills

Independent work

Typing speed 35 wpm

10-key data entry

Education

Master of Public Health (MPH) or related health care field

Medical Graduate or Dental Graduate

Job description

Central Maine Medical Center, part of Prime Healthcare Foundation, is seeking a utilization review/case management professional in Lewiston, ME to coordinate clinical reviews, participate in UR meetings, and educate departments on utilization processes.

Must have MPH or related health care degree and medical or dental graduate credentials. Strong knowledge of clinical pathophysiology and pharmacology is required; excellent communication and teamwork are essential.