Medical Utilization & Case Management Coordinator

Prime Healthcare; North Las Vegas (NV); On-site; USD 95,000 - 125,000; Full time

Job summary

North Vista Hospital in North Las Vegas, NV seeks a seasoned Utilization Review/Case Management professional to join its award-winning team. You will coordinate clinical reviews of patient records, participate in UR meetings, and educate departments on admission criteria and workflow.

The role requires MPH or related field, medical or dental degree, and knowledge of clinical pathophysiology and pharmacology.

Qualifications

• MPH or related health care field required.
• Medical or Dental graduate required.
• Knowledge of clinical pathophysiology and pharmacology required.
• ECFMG certification and/or US-based health and human services degree highly preferred.

Responsibilities

• Coordinate and complete clinical reviews for patient medical records; work with CMO and UR meetings.
• Participate in Case Management and UR meetings; educate departments on criteria and processes.
• Review patient charts to ensure admission/continuation criteria are met; gather data for payer requests.
• Coordinate discharge referrals and communicate status of accounts across departments.

Skills

Communication skills

Critical thinking

Interpersonal skills

Team collaboration

Education

MPH or related health care field

Medical Graduate

Dental Graduate

ECFMG Certification

Health/Human Services degree (US-based)

Tools

10-key data entry

Job description

North Vista Hospital in North Las Vegas, NV seeks a seasoned Utilization Review/Case Management professional to join its award-winning team. You will coordinate clinical reviews of patient records, participate in UR meetings, and educate departments on admission criteria and workflow.

The role requires MPH or related field, medical or dental degree, and knowledge of clinical pathophysiology and pharmacology.