Medical Review Coordinator - Utilization Review

Prime Healthcare; Olympia Fields (IL); On-site; USD 44,000 - 64,000; Full time

Job summary

Prime Healthcare's Olympia Fields Hospital in Olympia Fields, IL is hiring for a Utilization Review role. This on-site, full-time position involves coordinating clinical reviews, supporting case management meetings, and educating departments to ensure appropriate admission and treatment criteria are met.

The role requires MPH or equivalent health-care training, with medical or dental degrees and knowledge of pathophysiology and pharmacology.

Qualifications

• Requires MPH or related health care field (or equivalent).
• Medical Graduate or Dental Graduate required.
• Knowledge of clinical pathophysiology and pharmacology required.

Responsibilities

• Coordinate and complete clinical reviews of patient records for utilization review.
• Participate in Case Management and UR meetings and act as educator to departments.
• Review charts to assess admission/continuation criteria and gather data for payer requests.

Skills

Critical thinking

Communication skills

Time management

Education

MPH or related health care field

Medical or Dental degree

Knowledge of pathophysiology & pharmacology

ECFMG certification or US health & human services degree

UR/Case Management experience

Acute care experience (1+ year)

Job description

Overview

Department: Utilization Review

Shift: Full-Time, On-Site

Facility: Olympia Fields Hospital

Location: Olympia Fields,Illinois60461

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:

• Master of Public Health (MPH) or post-graduation in a related health care field is required.
• Medical Graduate, Dental Graduate required.
• Knowledge of Clinical Pathophysiology and Pharmacology 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/Case Management experience is highly preferred.
• 1+ year of 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.
• Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.

Pay Transparency

Olympia Fields 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 $32 to $46.35 on an hourly basis. 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.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

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. 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