Clinical Utilization Review Coordinator

Dallas Regional Medical Center; Mesquite (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

Dallas Regional Medical Center is seeking aIST Utilization Review/Case Management professional to coordinate clinical reviews of patient records and participate in UR/Case Management meetings. The role requires MPH or related health care training and medical or dental degrees with strong knowledge of pathophysiology and pharmacology.

The ideal candidate will work closely with the Chief Medical Officer, educate departments, and manage chart reviews, payer data requests, and discharge referrals.

Qualifications

• Master of Public Health or related health care field is required.
• Medical or Dental graduation is required.
• Knowledge of clinical pathophysiology and pharmacology is required.

Responsibilities

• Coordinates and completes clinical reviews for patient medical records with the CMO.
• Participates in Case Management and Utilization Review meetings.
• Educates departments on review processes and criteria.
• Reviews charts to assess admission/continuation criteria and responds to payer requests.
• Coordinates discharge referrals with clinical staff and families.

Skills

Communication

Case Management

Clinical knowledge

Independent judgment

Education

MPH or related health care field

Medical or Dental degree

ECFMG certification or US degree preferred

Bachelor's or higher in Health & Human Services (preferred)

Job description

Dallas Regional Medical Center is seeking aIST Utilization Review/Case Management professional to coordinate clinical reviews of patient records and participate in UR/Case Management meetings. The role requires MPH or related health care training and medical or dental degrees with strong knowledge of pathophysiology and pharmacology.

The ideal candidate will work closely with the Chief Medical Officer, educate departments, and manage chart reviews, payer data requests, and discharge referrals.