Medical Review Coordinator

Centinela Hospital Medical Center; Chicago (IL); On-site; USD 45,000 - 66,000; Full time

Benefits offered by this job

401K

Tuition reimbursement

Medical/dental/vision

Job summary

Resurrection Medical Center in Chicago seeks a Utilization Management professional to coordinate and review medical records, participate in Case Management and Treatment Team meetings, and educate departments on utilization reviews. Responsibilities include confirming admission criteria, gathering data for payers, and communicating status of open and closed accounts.

Qualifications include medical, dental, PA, or nursing graduate status, with a preference for ECFMG or US health/societies

Qualifications

• Education requirement: Medical/Dental/PA/Nursing graduate.
• ECFMG certification or US-based health/ HHS degree preferred.
• Utilization Review experience preferred.
• Acute care clinical experience preferred.
• Strong written/verbal communication and critical thinking skills.
• Ability to work independently in a time‑oriented environment.

Responsibilities

• Review patient charts to assess admission and continuation of treatment.
• Coordinate discharge referrals with clinical staff and families.
• Gather data and respond to records requests from payers and intermediaries.
• Participate in Case Management and Treatment Team meetings.
• Educate departments on utilization management practices.

Skills

Communication

Critical thinking

Interpersonal skills

Independent work

Time management

Education

Medical, Dental, PA, or Nursing graduate

ECFMG cert or US health-sciences degree preferred

Job description

Overview

• Department: Utilization Management
• Schedule: Full-time days
• Facility: Resurrection Medical Center
• Location: 7435 W Talcott Ave, Chicago, IL 60631

Responsibilities

Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings. Serves as on-going educator to all departments. Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. Performs other duties as assigned.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1. Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.

Preferred qualifications:

1. ECFMG Certification And/or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.

2. Utilization Review experience is highly preferred.

3. Clinical experience in acute care setting preferred.

4. Excellent written and verbal communication skills. Excellent critical thinking skills.

5. Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.

6. Ability to work independently in a time-oriented environment

Pay Transparency

Resurrection Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $33 to $47.79 The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf