Overview
Join an award-winning team of dedicated professionals committed to our core values of quality, compassion, and community! Saint Mary’s Health Network, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. As a long‑standing community partner with a 116-year history, Saint Mary’s Health Network provides Northern Nevada inpatient, outpatient, ancillary, and wellness services. The Saint Mary’s Regional Medical Center is a 352‑bed acute‑care hospital recognized by the Joint Commission, named one of the Top 100 Hospitals by Fortune/Merative and one of Healthgrades’ Best 250 hospitals. The health system operates a fully integrated medical group, urgent care clinics, imaging, lab, and primary care clinics. For more information, visit www.SaintMarysReno.com.
Responsibilities
Coordinate and review all medical records assigned to caseload.
Actively participate in Case Management and Treatment Team meetings.
Serve as an ongoing educator to all departments.
Review patient charts to assess whether admission and continuation criteria are met; gather data and respond to requests for records from payers or fiscal intermediaries.
Gather clinical and fiscal information and communicate status of open and closed accounts for utilization review and case management reporting.
Coordinate discharge referrals as requested by clinical staff, fiscal intermediaries, patients, and families.
Perform other duties as assigned.
Qualifications
Required Qualifications
Medical Graduate, Dental Graduate, PA, or Nursing Graduate.
Preferred Qualifications
ECFMG certification and/or a bachelor’s degree or higher from a U.S. accredited institution in a Health and Human Services field.
Utilization review experience.
Clinical experience in an acute‑care setting.
Excellent written and verbal communication skills.
Excellent critical‑thinking skills.
Excellent interpersonal skills to build effective partnerships with physicians, nurse staff, coding staff, and hospital management.
Ability to work independently in a time‑oriented environment.
Employment Details
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 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