Overview Montclair Hospital Medical Center is a 106-bed acute care, not-for-profit community hospital, and has received recognitions including the “100 Top Hospital” 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 the Montclair Hospital Medical Center website. Our dedicated team of professionals is committed to our core values of quality, compassion, and community. Montclair Hospital Medical Center is a member of Prime Healthcare and offers 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
Medical
Dental
Vision Coverage
Tuition Reimbursement
Many more
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. 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 the Chief Medical Officer (CMO). Actively participates in the Case Management and Utilization Review (UR) meetings. Serves as an ongoing educator to all departments. Responsible for reviewing patient charts to assess whether the clinical criteria for admission and continuation of treatment are being met; gathers data and responds to requests for records from payers/fiscal intermediaries, etc.; gathers clinical and fiscal information and communicates the status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Ability 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 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-graduate in a related health care field preferred. 3) Clinical experience in an acute care setting preferred. 4) Excellent written and verbal communication skills; strong critical thinking abilities. 5) Excellent interpersonal skills to build effective partnering relationships with physicians, nursing staff, coding staff, and hospital management staff. 6) Ability to work independently in a time-oriented environment. 7) Computer data entry with 10-key, 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, with consideration of factors such as skillset, years of applicable experience, education, credentials, and licensure.
Employment Status: Full Time
Equal Employment Opportunity: The Company is an equal employment opportunity employer and prohibits discrimination based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (as permitted by 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 these protected categories. Privacy Notice: Privacy Notice for California Applicants.