Medical Review Coordinator

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Harlingen 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.

 

Harlingen Medical Center is a Level IV Trauma Designated hospital that specializes in Cardiovascular Service, Emergency Services, Neuroscience, Orthopedic Services, Radiology, Rehabilitation Services and Surgical Services. Harlingen Medical Center has provided high-quality “Patient Focused Care” to the residents of Western Cameron County for more than 15 years. Harlingen Medical Center, one of South Texas’s best kept secrets, offers patients the best of both worlds--a warm, caring environment, close to home while providing the wide range of services and expertise typically found in much larger facilities.

 

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: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_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 Experience

Required qualifications:

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

Medical Graduate, Dental Graduate required.

Knowledge of Clinical Pathophysiology and Pharmacology required.

Preferred qualifications:

ECFMG Certification And/or Bachelors or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.

Utilization Review/Case Management experience is highly preferred.

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

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

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

Ability to work independently in a time-oriented environment.

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