Medical Review CoordinatorFacility

　　Roxborough Memorial HospitalLocationUS-PA-Philadelphia

　　ID2023-147173

　　CategoryBusiness Professional

　　Position TypeFull Time

　　ShiftDays

　　Job TypeNon-Exempt

　　Overview

　　Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Roxborough Memorial Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.Roxborough Memorial Hospital is a 131-bed community hospital. The hospital has been serving the medical and health care needs of the Roxborough, Manayunk, East Falls and northwest section of Philadelphia communities for more than a century, having first opened its doors in 1890. Roxborough Memorial Hospitals School of Nursing has been educating nurses since 1898. The hospital is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nation's oldest and largest hospital accreditation agency.We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics.  If you need special accommodation for the application process, please contact Human Resources.  Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOCKnowYourRightsscreenreader10_20.pdf

　　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 and Work ExperienceRequired 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.

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　　We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender,gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.EEO is the Law: http://www1.eeoc.gov/employers/upload/e ocselfprint_poster.pdf