Medical Review Coordinator

Centinela Hospital Medical Center; North Las Vegas (NV); Vor Ort; USD 90.000 - 120.000; Vollzeit

Zusammenfassung

North Vista Hospital in North Las Vegas, NV, seeks a qualified professional for Utilization Review/Case Management. The role focuses on reviewing patient records, ensuring admission and treatment criteria are met, and coordinating discharge planning with clinical and financial teams.

The position requires MPH or related health field and clinical background, with preferred UR/CM experience and strong communication skills to collaborate with physicians, nurses, and payers.

Qualifikationen

• Master of Public Health (MPH) or related health care field is required.
• Medical Graduate, Dental Graduate required.
• Knowledge of Clinical Pathophysiology and Pharmacology required.
• ECFMG Certification And/or Bachelor’s or higher from a US-based accredited Health/HH S program highly preferred.
• Utilization Review/Case Management experience preferred.
• 1+ year of clinical experience in acute care setting preferred.
• Excellent written and verbal communication skills and critical thinking.
• Excellent interpersonal skills to build partnerships with physicians, nurses, coding staff and hospital management.
• Ability to work independently in a time-oriented environment.
• Typing speed of 35 wpm preferred.

Aufgaben

• Coordinates and completes the clinical reviews for all patient medical records, working with the Chief Medical Officer.
• Participates in Case Management and Utilization Review meetings.
• Acts as an ongoing educator to all departments.
• Reviews patient charts to assess admission/continuation criteria and gathers data for payers and records requests.
• Gathers clinical and fiscal information and communicates status of open and closed accounts for UR/CM reporting.
• Coordinates discharge referrals as requested by clinical staff, payers, and families.
• Performs other duties as assigned.

Jobbeschreibung

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