Medical Review Coordinator - SMRMC Utilization Mgmt

As a long-standing community partner with a 116-year history, Saint Mary’s Health Network offers Northern Nevada inpatient, outpatient, ancillary, and wellness services. Nationally recognized and accredited by the Joint Commission, as well as named one of the Top 100 Hospitals by Fortune/Merative and America’s Best 250 hospitals by Healthgrades, Saint Mary’s Regional Medical Center is a 352-bed acute care hospital offering a robust line of inpatient, outpatient and ancillary services including a top-rated Center for Cancer, surgical and orthopedic services, and an award-winning Cardiology program and more. The health system, a member of Prime Healthcare, also operates a fully-integrated Medical Group, multiple urgent care clinics, freestanding imaging, lab, and primary care clinics.

For more information, visit www. SaintMarysReno.com.

Responsibilities

Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief Medical Officer). Actively participates in the Case management and UR meetings. Serves as on-going educator to all departments.

Responsible for reviewing patient charts in order to assess whether the clinical criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment.

Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. Performs other duties as assigned.

Qualifications

Education, experience, training

Required

qualifications

• Master of Public Health (MPH) or post-graduation in a related health care field is required.

• Medical Graduate, Dental Graduate required.

• Knowledge of Clinical Pathophysiology and Pharmacology required.

Preferred

qualifications

• ECFMG Certification And/or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.

• Utilization Review/Case Management experience is highly preferred.

• 1+ year of clinical experience in acute care setting preferred.

• Excellent written and verbal communication skills. Excellent critical thinking skills.

• Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.

• Ability to work independently in a time-oriented environment.

• Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.