Utilization Review Coordinator II - Clinical Records Lead

Saint Francis Hospital; Evanston (IL); On-site; USD 48,000 - 69,000; Full time

Benefits offered by this job

401K

Medical Insurance

Tuition Reimbursement

Paid Time Off

Job summary

Saint Francis Hospital in Evanston, IL, seeks a qualified Utilization Management professional to coordinate clinical reviews and aid in case management. The role requires reviewing patient charts to ensure admission criteria are met and communicating with payers and departments.

Responsibilities include data gathering, status reporting, and acting as an educator across departments, with a focus on compliance with federal, state, and intermediary guidelines. This is a full-time daytime position.

Qualifications

• Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.
• Two years of Utilization Review experience as a Medical Review Coordinator – I required.
• Knowledge of Clinical Pathophysiology and Pharmacology required.

Responsibilities

• Coordinate and complete clinical reviews for all patient medical records.
• Participate in Case Management and UR meetings.
• Educate departments on UR criteria and processes.

Skills

Utilization Review

Clinical Knowledge

Communication Skills

Education

ECFMG Certification / US Health Human Services degree

Master of Public Health (MPH)

Job description

Saint Francis Hospital in Evanston, IL, seeks a qualified Utilization Management professional to coordinate clinical reviews and aid in case management. The role requires reviewing patient charts to ensure admission criteria are met and communicating with payers and departments.

Responsibilities include data gathering, status reporting, and acting as an educator across departments, with a focus on compliance with federal, state, and intermediary guidelines. This is a full-time daytime position.