Senior Medical Review Coordinator – Utilization Management

Prime Healthcare; Evanston (IL); On-site; USD 48,000 - 69,000; Full time

Job summary

Prime Healthcare St Francis Hospital in Evanston, IL seeks a full-time Utilization Management professional to coordinate clinical reviews, work with the CMO, and support case management with data-driven decisions.

The candidate will review patient charts for admission and ongoing treatment criteria, gather data for payer requests, and coordinate discharge referrals while maintaining independence and sound judgment.

Qualifications

• Requires degree in medical field (MD/DO, dental, PA, or nursing).
• Two years Utilization Review experience as Medical Review Coordinator I.
• Knowledge of clinical pathophysiology and pharmacology.

Responsibilities

• Coordinate and complete clinical reviews for patient medical records with the CMO.
• Participate in Case management and UR meetings.
• Educate departments on utilization review processes.
• Review patient charts to assess admission/continuation criteria; gather data and respond to requests for records.
• Coordinate discharge referrals as requested by clinical staff, payers, patients and families.
• Work independently with sound judgment.
• Knowledge of federal, state and intermediary guidelines for inpatient and other levels of care.

Skills

Communication skills

Critical thinking

Interpersonal skills

Independent work

Typing speed 35 wpm

Education

Medical/Dental/PA/Nursing degree

US health-related bachelor's degree

MPH or related graduate degree

Job description

Prime Healthcare St Francis Hospital in Evanston, IL seeks a full-time Utilization Management professional to coordinate clinical reviews, work with the CMO, and support case management with data-driven decisions.

The candidate will review patient charts for admission and ongoing treatment criteria, gather data for payer requests, and coordinate discharge referrals while maintaining independence and sound judgment.