Medical Review Coordinator I

Prime Healthcare; Ontario (CA); On-site; USD 45,000 - 62,000; Full time

Job summary

Prime Healthcare in Ontario, California seeks a healthcare professional for Case Management/ Utilization Review to coordinate medical records, reviews, and discharge planning. You will participate in Treatment Team meetings and provide ongoing education to departments.

Ideal candidates hold a medical, dental, PA, or nursing degree with strong communication and analytical skills; acute care experience is preferred. Full-time, days shift, with comprehensive benefits.

Qualifications

• Must have healthcare graduate degree: medical, dental, PA, or nursing.
• Preferred: ECFMG certification and/orBachelor’s or higher from a US‑based HH field.
• Utilization Review experience and acute care setting experience preferred.
• Excellent written and verbal communication, critical thinking, and interpersonal skills.

Responsibilities

• Coordinates and reviews medical records, caseload assigned.
• Participates in Case Management and Treatment Team meetings.
• Educates departments on processes and criteria for admission/continuation of treatment.
• Reviews charts to assess admission criteria and communicates with payers and fiscal intermediaries.

Education

Medical Graduate

Dental Graduate

PA

Nursing Graduate

Job description

Prime Healthcare is an award‑winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty‑one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not‑for‑profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Prime Healthcare is an award‑winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty‑one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not‑for‑profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

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

Required qualifications:

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

Preferred Qualifications

• ECFMG Certification And/or Bachelor’s or higher from a US‑based accredited institution in a Health and Human Services field is highly preferred.
• Utilization Review experience is highly preferred.
• Clinical experience in acute care setting preferred.
• Excellent written and verbal communication skills. Excellent critical thinking skills.
• Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.
• Ability to work independently in a time‑oriented environment

Pay Transparency

Prime Healthcare 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 coverage
• Dental coverage
• Vision coverage
• Tuition reimbursement
• Many more voluntary benefit options

A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $33.00 to $45.74. 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.

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

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf