Medical Review Coordinator II - Social Work Services

Prime Healthcare; Passaic, Northern (NJ, KY); Hybrid; USD 36,000 - 56,000; Full time

Benefits offered by this job

401K retirement plan

Tuition reimbursement

Job summary

St. Mary's General Hospital in Passaic, NJ is seeking a Utilization Review Coordinator to review patient charts, confirm admission criteria, and coordinate discharge referrals in collaboration with clinical staff and payers.

The role supports case management and UR meetings, and demands strong judgment and independent work capabilities. Qualifications include a Medical, Dental, PA, or Nursing graduate with two years’ UR experience; strong communication and critical thinking skills are essential.

Qualifications

• Two years of Utilization Review experience as a Medical Review Coordinator – I.
• Excellent written and verbal communication skills.
• Excellent critical thinking skills.

Responsibilities

• Review patient charts to assess admission/continuation criteria.
• Coordinate discharge referrals as requested by clinical staff and payers.
• Participate in Case Management and UR meetings and provide education across departments.

Skills

Utilization Review

Communication skills

Critical thinking

Interpersonal skills

Education

Medical or NursingGraduate required

ECFMG Certification preferred

US Health/ Human Services degree preferred

MPH preferred

Job description

Overview

St. Mary's General Hospital, located in Passaic, NJ, is a community-based tertiary medical center focused on providing quality, compassionate care. It is an acute care hospital providing a broad range of services including cardiovascular services as well as a comprehensive program for cancer care. The hospital is also a center of excellence for maternal-child health and outpatient behavioral health services. It is the only hospital in Passaic and with over 550 physicians and 1,000 employees, and is one of the largest employers in the county. Every member of the St. Mary's General team is committed to providing respectful, personalized, high-quality care. St. Mary's General Hospital is a member of Prime Healthcare, which has been lauded as a "Top 15 Healthcare System" by Truven Health Analytics. For information, visit www.smh-nj.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, EXPERIENCE, TRAINING

Required qualifications:

• 1. Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.
• 2. Two years of Utilization Review experience as a Medical Review Coordinator – I required.
• 3. Knowledge of Clinical Pathophysiology and Pharmacology 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. Master of Public Health (MPH) or post-graduation in a related health care field 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.
• 7. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.

Pay Transparency

St. Mary's General Hospital 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 $26.25 to $40.90. 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