Medical Review Coordinator - Utilization Review

Centinela Hospital Medical Center; Mesquite (TX); On-site; USD 85,000 - 110,000; Full time

Job summary

Dallas Regional Medical Center in Dallas, TX, is seeking an experienced Utilization Review / Case Management reviewer to coordinate clinical reviews across patient records and payer requests.

You will participate in UR and Case Management meetings, educate departments on guidelines, and manage discharge referrals while applying federal and state requirements to inpatient care.

Qualifications

• Master of Public Health (MPH) or related health care field is required.
• Medical Graduate or Dental Graduate required.
• Knowledge of Clinical Pathophysiology and Pharmacology.

Responsibilities

• Coordinate clinical reviews for patient medical records with the CMO.
• Participate in Case Management and UR meetings.
• Educate departments on guidelines and processes.
• Coordinate discharge referrals and respond to payer requests.
• Work independently with sound judgment and knowledge of inpatient care guidelines.

Skills

Communication skills

Critical thinking

Interpersonal skills

Education

MPH or related health care field

Medical or Dental graduate

Job description

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion, and community! Dallas Regional Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Dallas Regional Medical Center is a 202-bed acute care hospital accredited by The Joint Commission that offers a wide range of medical services including 24/7 emergency care, cardiology, wound care, surgical services, cardiac catheterization, and imaging. The hospital is the only Certified Stroke Center, Accredited Chest Pain Center, and Labor and Delivery Unit in the area. In addition, Dallas Regional is the only Trauma Center for 13 miles, and was the first Accredited Geriatric Emergency Room in Dallas County. The hospital is a recipient of Healthgrades Patient Safety Excellence Awards, 15 Healthgrades Five-Star ratings over the past three years, and Straight \"A\" Hospital Safety Grades from The Leapfrog Group since 2018. For more information visit www.dallasregionalmedicalcenter.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 Bachelor's 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