Medical Review Coordinator I - Utilization Management Job at Saint Joseph Medical Center - Joliet, Joliet, IL

ay8yaDExSjlEZVR0UExWTGlTYUN3ZFN2Mmc9PQ==
  • Saint Joseph Medical Center - Joliet
  • Joliet, IL

Job Description

Overview

Department:  Utilization Management 

Schedule:  Days, M-F, 8am-4:30pm 

Facility:  Prime Healthcare St. Joseph Hospital of Joliet

Location: Joliet, IL 60435

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights:

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:

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

2.    Medical Graduate, Dental Graduate required.

3.    Knowledge of Clinical Pathophysiology and Pharmacology required.

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/Case Management experience is highly preferred. 

3.    1+ year of clinical experience in acute care setting preferred.

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

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

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

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

Saint Joseph Medical Center - Joliet offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $32.00 to $46.35. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

#LI-MP2

Job Tags

Full time, Local area,

Similar Jobs

Onvida Health

HIM Coding Supervisor Job at Onvida Health

 ...Summary: Under the general supervision of the Coding Manager or designee, the Medical Coding Supervisor is responsible for performing and supervising...  ...Education Required: Associate's degree in medical Billing and Coding or equivalent Certified Professional... 

Experience Senior Living

Chauffeur/Driver (Part Time) Job at Experience Senior Living

 ...caregivers, all focused on making a positive impact on the lives of residents, their families and team members. We are looking for a Chauffeur to join our amazing team! Shift: Part Time | Wednesday & Fridays only Responsibilities: Drive vehicle from community... 

iAnthus Capital

Cannabis Harvester - MPX/Health For Life (Mesa) Job at iAnthus Capital

 ...Who We Are: iAnthus Capital Management is a multi-state operator, encompassing the full spectrum of cannabis enterprises, from cultivation to processing to retailing. Cannabis will be the next great transformative industry - not just because it has the power to change... 

Hyatt

Bartender-Restaurant 1 Job at Hyatt

 ...Street Standard, to sweeping views of downtown Sacramento from the Clayton Club rooftop, our onsite dining options boast West Coast culinary fare and inspired cocktails, perfect for indulging. 7TH STREET STANDARD Find eclectic, fun, and unique West Coast-inspired fare at... 

Target

Ulta Beauty Consultant Job at Target

Starting Hourly Rate / Salario por Hora Inicial: $18.75 USD per hour**ALL ABOUT TARGET**Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here. (**ALL...