Clinical Utilization & Case Management Coordinator

Prime Healthcare; Mesquite (TX); On-site; USD 70,000 - 90,000; Full time

Job summary

Dallas Regional Medical Center, a Prime Healthcare facility, seeks an experienced Utilization Review/Case Management professional to coordinate clinical reviews of patient records and participate in UR meetings.

The role requires MPH or related field, clinical experience in acute care, knowledge of pathophysiology and pharmacology, and strong communication skills to collaborate with physicians, staff and payers.

Qualifications

• Master of Public Health or related health care field required.
• Medical or dental degree required.
• Knowledge of clinical pathophysiology and pharmacology required.
• ECFMG certification and/or US-based Health and Human Services degree preferred.
• Utilization Review/Case Management experience preferred.
• 1+ year of clinical experience in acute care preferred.
• Excellent written and verbal communication skills.
• Excellent interpersonal skills to build relationships with physicians, staff and management.
• Ability to work independently in a time-oriented environment.
• Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.

Responsibilities

• Coordinates and completes the clinical reviews for all patient medical records in collaboration with the Chief Medical Officer.
• Participates in Case Management and Utilization Review meetings.
• Educates departments on processes and criteria for admission, continuation of treatment, and payers' requests.
• Reviews patient charts to assess admission criteria and treatment goals; gathers data for payer requests.
• Gathers clinical and fiscal information and communicates status of open/closed accounts for UR reporting.
• Coordinates discharge referrals with clinical staff, payers, patients and families.
• Works independently with sound judgment and knowledge of federal/state guidelines for inpatient care.
• Performs other duties as assigned.

Skills

Excellent communication

Critical thinking

Interpersonal skills

Independent worker

Time management

Education

MPH or related health care field

Medical or Dental degree

ECFMG certification or US-based HH degree

US healthcare education preferred

Tools

10-key data entry

Typing 35 wpm

Job description

Dallas Regional Medical Center, a Prime Healthcare facility, seeks an experienced Utilization Review/Case Management professional to coordinate clinical reviews of patient records and participate in UR meetings.

The role requires MPH or related field, clinical experience in acute care, knowledge of pathophysiology and pharmacology, and strong communication skills to collaborate with physicians, staff and payers.