Clinical Utilization Review Coordinator II - Social Work

Prime Healthcare; Passaic (NJ); On-site; USD 36,000 - 56,000; Full time

Job summary

St. Mary’s General Hospital in Passaic, NJ, offers a full-time Utilization Review Coordinator role supporting clinical reviews of patient records and collaboration with the Chief Medical Officer.

The role involves participation in Case Management and UR meetings, with responsibilities across data gathering and education for departments. The position requires a medical, dental, PA, or nursing degree and 2 years UR experience, plus knowledge of pathophysiology and pharmacology.

Qualifications

• Required: Medical, Dental, PA or Nursing graduate.
• Two years of Utilization Review experience as Medical Review Coordinator – I.
• Knowledge of clinical pathophysiology and pharmacology.

Responsibilities

• Coordinate and complete the clinical reviews for patient medical records with the CMO.
• Participate in Case Management and Utilization Review meetings; educate departments.
• Review charts to assess admission/continuation criteria; gather data for payers and records requests.
• Coordinate discharge referrals with clinical staff, payers, patients, and families.

Skills

Utilization Review

Clinical Pathophysiology

Pharmacology

Education

Medical/Dental/PA/Nursing graduate

ECFMG Certification (preferred)

Health/Human Services degree (Bachelor+) (preferred)

Job description

St. Mary’s General Hospital in Passaic, NJ, offers a full-time Utilization Review Coordinator role supporting clinical reviews of patient records and collaboration with the Chief Medical Officer.

The role involves participation in Case Management and UR meetings, with responsibilities across data gathering and education for departments. The position requires a medical, dental, PA, or nursing degree and 2 years UR experience, plus knowledge of pathophysiology and pharmacology.