Utilization Review Medical Coordinator

St. Mary’s Hospital - Kankakee; Kankakee (IL); On-site; USD 42,706,000 - 61,854,000; Full time

Job summary

St. Mary's Hospital in Kankakee, IL is seeking a Utilization Review professional to coordinate and review medical records, assess admission criteria, and support case management.

The role requires independent judgment and knowledge of federal, state, and intermediary guidelines for inpatient and other levels of care. You will participate in Treatment Team meetings, educate departments, gather data for payers, coordinate discharge referrals, and support multiple levels of Utilization Review

Qualifications

• Must hold a medical, dental, PA, or nursing graduate degree.
• ECFMG certification or US-based bachelor’s or higher in Health & Human Services preferred.
• Utilization Review experience preferred.
• Clinical experience in acute care setting preferred.
• Strong written and verbal communication; excellent critical thinking; ability to work independently.

Responsibilities

• Review medical records to assess admission and continuation criteria; gather data and respond to payer requests.
• Participate in Case Management and Treatment Team meetings; educate departments.
• Coordinate discharge referrals with clinical staff, payers, and families; communicate status of accounts for Utilization Review reporting.

Skills

Excellent written and verbal comms

Critical thinking

Interpersonal skills

Independent work

Education

Medical Graduate / Dental Graduate / PA / Nursing Graduate

US-based Health & Human Services degree

Job description

St. Mary's Hospital in Kankakee, IL is seeking a Utilization Review professional to coordinate and review medical records, assess admission criteria, and support case management.

The role requires independent judgment and knowledge of federal, state, and intermediary guidelines for inpatient and other levels of care. You will participate in Treatment Team meetings, educate departments, gather data for payers, coordinate discharge referrals, and support multiple levels of Utilization Review