Medical Records & Utilization Review Coordinator

Prime Healthcare; California (MO); Hybrid; USD 45,000 - 63,000; Full time

Job summary

Prime Healthcare, headquartered in Ontario, California, seeks a healthcare professional to support case management and utilization review. You will review medical records, evaluate admission criteria, and communicate data across departments.

The role requires a medical, dental, PA, or nursing background, with preferred experience in utilization review and acute care settings. Strong communication and teamwork are essential for coordinating with physicians, staff, payers, and families.

Qualifications

• Medical, Dental, PA, or Nursing graduate required.
• ECFMG Certification or Bachelor’s in Health and Human Services highly preferred.
• Utilization Review experience highly preferred.
• Clinical experience in acute care setting preferred.
• Excellent written and verbal communication skills.
• Excellent interpersonal skills to build relationships with physicians and staff.
• Ability to work independently and use sound judgment.

Responsibilities

• Coordinate and review medical records for caseloads as assigned.
• Participate in Case Management and Treatment Team meetings.
• Serve as educator to departments regarding criteria and processes.
• Review charts to assess admission/continuation criteria and respond to payer requests.
• Gather clinical and fiscal data and report status for Utilization Review.
• Coordinate discharge referrals with staff, payers, patients and families.

Skills

Communication skills

Critical thinking

Interpersonal skills

Education

Medical/Dental/PA/Nursing graduate

ECFMG Certification or health & human services bachelor

Job description

Prime Healthcare, headquartered in Ontario, California, seeks a healthcare professional to support case management and utilization review. You will review medical records, evaluate admission criteria, and communicate data across departments.

The role requires a medical, dental, PA, or nursing background, with preferred experience in utilization review and acute care settings. Strong communication and teamwork are essential for coordinating with physicians, staff, payers, and families.