Utilization Review Specialist - Medical Records & Case Mgmt

Prime Healthcare; Kankakee (IL); On-site; USD 43,000 - 62,000; Full time

Job summary

Prime Healthcare's St. Mary's Hospital in Kankakee, IL seeks a full-time Utilization Review specialist to review medical records, participate in Case Management and Treatment Team meetings, and educate departments on processes.

You will assess admission/continuation criteria, gather data for payers, coordinate discharge referrals, and communicate status for multiple accounts, using strong independent judgment and knowledge of federal/state guidelines.

Qualifications

• Medical, Dental, PA, or Nursing graduate required.
• ECFMG certification and/or Bachelor’s or higher in a US Health and Human Services field preferred.
• Utilization Review experience preferred.
• Clinical experience in acute care setting preferred.
• Excellent written and verbal communication and critical thinking.
• Strong interpersonal skills and ability to work independently.

Responsibilities

• Coordinates and reviews medical records for assigned caseload.
• Participates in Case Management and Treatment Team meetings.
• Educates departments on Utilization Review processes.
• Reviews charts to assess admission and continuation criteria.
• Gathers data for payers and communicates status of accounts.
• Cooperates with discharge referrals and coordinates with staff and families.

Skills

Communication skills

Critical thinking

Interpersonal skills

Independent work

Education

Medical Graduate

Dental Graduate

PA

Nursing Graduate

Job description

Prime Healthcare's St. Mary's Hospital in Kankakee, IL seeks a full-time Utilization Review specialist to review medical records, participate in Case Management and Treatment Team meetings, and educate departments on processes.

You will assess admission/continuation criteria, gather data for payers, coordinate discharge referrals, and communicate status for multiple accounts, using strong independent judgment and knowledge of federal/state guidelines.