Medical Review Coordinator - Social Work Services

Overview

Join an award-winning team of dedicated professional 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, established in 1890, is a 131-bed community hospital and part of Prime Healthcare's Pennsylvania Region. Prime Healthcare Pennsylvania Region includes Roxborough Memorial Hospital in Philadelphia, Lower Bucks Hospital in Bucks County, and Suburban Community Hospital in Montgomery County.

Prime's hospitals in Pennsylvania are certified by The Joint Commission as Primary Stroke Centers and have won multiple awards through Healthgrades and the Get With The Guidelines Quality Achievement Awards though the American Heart Association. Our hospitals offer medical, surgical, and emergency care, which includes diagnostic radiology, lab services, behavior health, heart care, rehabilitation, family medicine, wound care, and residency programs.

Through high quality medical care, educational programs, and community outreach services, our hospitals treat all members of our communities with respect and compassion. For more information visit www.roxboroughmemorial.com.

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/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:

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

2. Medical 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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