Clinical Utilization & Review Coordinator

St. Mary's General Hospital; Passaic (NJ); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Total rewards package

Tuition reimbursement

401K plan

Medical, dental, and vision coverage

Job summary

St. Mary's General Hospital in Passaic, NJ is a community-based tertiary medical center offering comprehensive cardiovascular, cancer, and maternal-child health services.

The role involves coordinating clinical reviews of patient records, participating in utilization reviews, and educating departments to ensure adherence to admission and treatment criteria. The position requires MPH or related health field, with medical or dental degrees and strong communication, critical thinking, and

Qualifications

• Master of Public Health (MPH) or post-graduation in a related health care field is required.
• Medical Graduate or Dental Graduate required.
• Knowledge of Clinical Pathophysiology and Pharmacology required.
• ECFMG Certification and/or US health-related degree highly preferred.

Responsibilities

• Coordinate and complete clinical reviews for all patient medical records with CMO.
• Participate in Case Management and UR meetings.
• Educate departments on relevant processes and guidelines.
• Review patient charts to assess admission and treatment criteria; gather data for payer requests and reports.
• Coordinate discharge referrals with clinical staff and families.
• Work independently with sound judgment and adherence to federal/state guidelines.

Skills

Communication skills

Critical thinking

Interpersonal skills

Independent work

Education

MPH or related health care field

Medical or Dental degree

ECFMG Certification (preferred)

US-based health and human services degree (preferred)

Tools

10-key data entry

Job description

St. Mary's General Hospital in Passaic, NJ is a community-based tertiary medical center offering comprehensive cardiovascular, cancer, and maternal-child health services.

The role involves coordinating clinical reviews of patient records, participating in utilization reviews, and educating departments to ensure adherence to admission and treatment criteria. The position requires MPH or related health field, with medical or dental degrees and strong communication, critical thinking, and