What are the responsibilities and job description for the Utilization Review Coordinator position at Prime Healthcare?
Overview
St. Mary's General Hospital, located in Passaic, NJ, is a community-based tertiary medical center focused on providing quality, compassionate care. It is an acute care hospital providing a broad range of services including cardiovascular services as well as a comprehensive program for cancer care. The hospital is also a center of excellence for maternal-child health and outpatient behavioral health services. It is the only hospital in Passaic and with over 550 physicians and 1,000 employees, and is one of the largest employers in the county. Every member of the St. Mary's General team is committed to providing respectful, personalized, high-quality care. St. Mary's General Hospital is a member of Prime Healthcare, which has been lauded as a "Top 15 Healthcare System" by Truven Health Analytics. For information, visit .
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Responsibilities
Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings. Serves as on-going educator to all departments. Responsible for reviewing patient charts in order to assess whether the 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 and Work Experience
Required qualifications :
1. Bachelor’s degree in Medicine or Nursing or related Clinical field.
Preferred qualifications :
1. ECFMG Certification And / or Bachelor’s or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
2. Utilization Review experience is highly preferred.
3. Must meet the performance standards set forth by the Hospital / Department at UR Coordinator position for at least 6 months.
4. 1 year of clinical experience in acute care setting preferred.
5. Excellent written and verbal communication skills. Excellent critical thinking skills.
