Medical Review Coordinator

Prime Healthcare; Las Vegas, Northern (NV, KY); Sur place; USD 80 000 - 105 000; Plein temps

Résumé du poste

North Vista Hospital, a Prime Healthcare facility in North Las Vegas, seeks a qualified Utilization Review/Case Management professional to join its award-winning team. The role focuses on clinical review of patient records, coordinating with the Chief Medical Officer, and supporting admission decisions and discharge planning.

Required MPH or related healthcare degree, medical graduate credentials, and knowledge of clinical pathophysiology and pharmacology; experience in case management and UR is

Qualifications

• MPH or related health care field is required.
• Medical graduate credentials are required.
• Knowledge of Clinical Pathophysiology and Pharmacology is required.
• ECFMG certification or US-based degree is highly preferred.

Responsabilités

• Review patient charts to assess criteria for admission and continuation of treatment.
• Coordinate data and respond to payer/fiscal intermediary requests.
• Attend UR and Case Management meetings; educate departments.
• Communicate status of open/closed accounts for Utilization Review reporting.
• Coordinate discharge referrals with clinical staff and families.

Connaissances

Critical thinking

Communication skills

Interpersonal skills

Independent work

Time management

Documentation accuracy

Formation

MPH or related healthcare field

Medical Graduate

ECFMG certification / US-education

Outils

10-key data entry

Computer literacy

Description du poste

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