Clinical Utilization & Review Coordinator

Prime Healthcare; Passaic (NJ); On-site; USD 85,000 - 110,000; Full time

Job summary

St. Mary's General Hospital in Passaic, NJ, is seeking a Utilization Review Specialist to coordinate clinical reviews of patient records, support Case Management/UR meetings, and educate departments on admission criteria and payer communications.

The role requires MPH or related health care education and a medical background; preferred UR/Case Management experience and strong communication skills for collaboration with physicians, staff, and payers.

Qualifications

• Education and experience in Utilization Review or Case Management preferred.
• Strong written and verbal communication skills.
• Ability to analyze clinical data and apply criteria for admission and continuation of treatment.

Responsibilities

• Coordinates and completes clinical reviews for patient medical records.
• Participates in Case Management and UR meetings.
• Educates departments on admission criteria and payer/fiscal intermediary requirements.
• Reviews charts to assess compliance with inpatient admission criteria and communicates status of accounts.

Job description

St. Mary's General Hospital in Passaic, NJ, is seeking a Utilization Review Specialist to coordinate clinical reviews of patient records, support Case Management/UR meetings, and educate departments on admission criteria and payer communications.

The role requires MPH or related health care education and a medical background; preferred UR/Case Management experience and strong communication skills for collaboration with physicians, staff, and payers.