Medical Utilization Review Analyst
1 month ago
At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Work Shifts
8:00 A.M - 4:00 P.M
Job Description
Under supervision provides clinically oriented analysis of patient care records for purposes of determining compliance with predetermined standards for quality of care and with standards and regulations of regulatory agencies in an effort to improve the quality of care rendered to patients and to maximize reimbursement from third-party and self payers.
Duties & Responsibilities
1. Analyzes patient records to determine that the medical records documentation reflects the appropriateness and medical necessity of hospitalization.
2. On a concurrent basis, identifies and reports trends and patterns of care which deviate from established norms.
3. As required, consults with medical, nursing and other staff involved in treatment to clarify issues and secure documentation of the records.
4. Initiates action and/or works with the Social Service Department to monitor timely discharge planning.
5. Extrapolates requested medical information from records for Utilization Review and other committees and may otherwise participate as a member of the committee(s).
6. Maintains appropriate files and other clerical records to ensure timely review and processing of records.
7. May participate in special studies relating to Utilization Review and Quality Assurance.
8. Keeps informed of changes in regulations, procedures and treatment standards prescribed by the hospital, regulatory and/or reimbursement agencies.
9. Performs related work
Minimum Qualifications
1. An Associate Degree in Science which includes courses in Biology, Chemistry, Anatomy or related subjects, and two years of experience in a hospital clinical setting in a capacity which provides thorough understanding of medical diagnosis, symptoms and treatment concepts; or
2. Certification as an Accredited Records Technician and two years of experience in a setting in a capacity which provides thorough understanding of hospital medical diagnostic and treatment concepts and terminology; and
3. Ability to understand and extrapolate medical information from records and through discussion with medical and nursing staff; and
4. Knowledge of third-party reimbursement systems.
If you wish to apply for this position, please apply online at employment.nychhc.org.
NYC Health and Hospitals offers a competitive benefits package that includes:
- Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
- Retirement Savings and Pension Plans
- Loan Forgiveness Programs for eligible employees
- Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
- College tuition discounts and professional development opportunities
- Multiple employee discounts programs
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