Medical Review Coordinator

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Garden Grove Hospital 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. Founded in 1982, Garden Grove Hospital Medical Center is a 167-bed community hospital centrally located in beautiful Southern California dedicated to providing our community with high-quality, compassionate healthcare. Garden Grove Hospital Medical Center has received “Top 100 Hospital” in the nation accolades from Truven Health Analytics and is a recipient of the Patient Safety Excellence Award from Healthgrades. Key services include general medical/surgical inpatient care and treatment, critical care, emergency services, orthopedics, maternity care, and wound care. The facility offers a full spectrum of acute care services for the residents of Garden Grove and the surrounding communities. Located near the corner of Harbor and Garden Grove Boulevards, Garden Grove Hospital is close to the Disneyland Resort, the Anaheim Convention Center, and the many hotels situated in the area. For more information, visit gardengrovehospital.com.

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 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. Works with health information management staff, coding staff, physicians, financial services, onsite and remote utilization review teams with regards to admission criteria, medical necessity, payment denials, and documentation issues. 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.

Garden Grove 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 $30.00 to $44.11. 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

Shift

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: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

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