Medical Review Coordinator

Prime Healthcare Services; Las Vegas (NV); On-site; USD 85,000 - 110,000; Full time

Job summary

North Vista Hospital in North Las Vegas, NV, is seeking a dedicated professional to coordinate and complete clinical reviews of patient medical records within Utilization Review and Case Management. The role involves collaboration with the Chief Medical Officer, reviewing charts for admission criteria, and communicating status to payers and families.

Required MPH or related field, medical graduate, and knowledge of pathophysiology and pharmacology.

Qualifications

• Must be able to review patient charts to assess admission criteria.
• Coordinate with CMO and UR meetings.
• Provide ongoing education to departments and coordinate discharge referrals.

Responsibilities

• Coordinate and complete clinical reviews for patient medical records.
• Work with CMO and UR meetings.
• Review charts to ensure admission/continuation criteria are met.
• Gather data for payer requests and communicate status of accounts.

Skills

Clinical review coordination

Case management collaboration

Medical terminology

Communication skills

Typing speed 35 wpm

Education

MPH or related health care field

Medical Graduate

ECFMG Certification (preferred)

Job description

Overview

At North Vista Hospital, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, North Vista Hospital is actively seeking new members to join its award-winning team!

North Vista Hospital is an accredited 177-bed state-of-the-art hospital located in North Las Vegas, Nevada.North Vista offers comprehensive healthcare services, including mental health care, emergency care, heart care, advanced surgical procedures, diagnostic imaging and help for a broad range of medical conditions. Equipped with advanced medical technology and staffed by a team of highly skilled healthcare professionals, North Vista is committed to providing high-quality care in a friendly hospital environment. The hospital has achieved numerous quality award distinctions including Patient Safety Excellence Award, Bariatric Surgery Excellence Award, Heart Failure recognition and more. For more information, please visit www.northvistahospital.com.

Responsibilities

Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief Medical Officer). Actively participates in the Case management and UR meetings. Serves as on-going educator to all departments. Responsible for reviewing patient charts in order to assess whether the clinical 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 and Work Experience

Required qualifications:

1. Master of Public Health (MPH) or post-graduation in a related health care field is required.

2. Medical Graduate, Dental Graduate required.

3. Knowledge of Clinical Pathophysiology and Pharmacology required.

Preferred qualifications:

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

2. Utilization Review/Case Management experience is highly preferred.

3. 1+ year of 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.

7. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.

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