Medical Review Coordinator II - RRAL

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Riverview Regional Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Located in Gadsden, Alabama, Riverview Regional Medical Center is a 281-bed acute-care hospital serving more than 350,000 residents in Etowah and the contiguous counties. A full range of services and programs are offered, including the only accredited Cath Lab in Northeast Alabama, Sleep Lab, Wound Care and Hyperbaric Center, and Women’s Diagnostic Imaging Center. Riverview Regional Medical Center is accredited by The Joint Commission (TJC) and is rated among the top 5% of hospitals in the nation for patient safety. Riverview is also the areas highest rated hospital, receiving Four-Stars from the Centers for Medicare and Medicaid (CMS). Originally named Holy Name of Jesus Hospital, Riverview Regional Medical Center was founded in 1917 by the Sisters of the Missionary Servants of the Most Blessed Trinity. Riverview was purchased by Prime Healthcare in 2016. Together they continue a mission of providing quality healthcare in the community it so proudly serves. To learn more about Riverview Regional Medical Center and the services it provides, visit

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. Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.

2. Three years of Utilization Review experience as a Medical Review Coordinator – I 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. Master of Public Health (MPH) or post-graduation in a related health care field preferred.

3. 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.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

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: