Medical Review Coordinator II - Social Work Services

Overview

Montclair Hospital Medical Center is a 106-bed acute care, not-for-profit community hospital, received the “100 Top Hospital” in the nation award from IBM Watson Health, the Patient Safety Excellence award from Healthgrades®, and the Women's Choice Award® for America's Best Emergency Care. For more information visit Montclair-hospital.org

 

At Montclair Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community! 

 

Why Prime Healthcare? Montclair Hospital Medical Center is a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

 

Our Total Rewards package includes, but is not limited to:

• Paid Time Off
• 401K retirement plan
• Outstanding Medical
• Dental
• Vision Coverage
• Tuition Reimbursement
• Many more Voluntary Benefit Options!

Benefits may vary based on collective bargaining agreement requirements and/or the employment status, i.e. full-time or part-time.

This is a Fast-paced work environment in which you can take pride in serving an underserved community. Come Join a Team of Dedicated Healthcare Workers!!!

 

Montclair Hospital Medical Center is nationally recognized, locally preferred, and community focused.

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.

Pay Transparency

Montclair Hospital Medical Center 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 $29.95 to $43.37. 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.

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 id