Clinical Utilization Review Coordinator

Prime Healthcare Services; Las Vegas (NV); On-site; USD 85,000 - 110,000; Full time

Job summary

North Vista Hospital in North Las Vegas, NV, is seeking a dedicated professional to coordinate and complete clinical reviews of patient medical records within Utilization Review and Case Management. The role involves collaboration with the Chief Medical Officer, reviewing charts for admission criteria, and communicating status to payers and families.

Required MPH or related field, medical graduate, and knowledge of pathophysiology and pharmacology.

Qualifications

• Must be able to review patient charts to assess admission criteria.
• Coordinate with CMO and UR meetings.
• Provide ongoing education to departments and coordinate discharge referrals.

Responsibilities

• Coordinate and complete clinical reviews for patient medical records.
• Work with CMO and UR meetings.
• Review charts to ensure admission/continuation criteria are met.
• Gather data for payer requests and communicate status of accounts.

Skills

Clinical review coordination

Case management collaboration

Medical terminology

Communication skills

Typing speed 35 wpm

Education

MPH or related health care field

Medical Graduate

ECFMG Certification (preferred)

Job description

North Vista Hospital in North Las Vegas, NV, is seeking a dedicated professional to coordinate and complete clinical reviews of patient medical records within Utilization Review and Case Management. The role involves collaboration with the Chief Medical Officer, reviewing charts for admission criteria, and communicating status to payers and families.

Required MPH or related field, medical graduate, and knowledge of pathophysiology and pharmacology.