Medical Review Analyst - Social Work

Overview

Department: Inpatient Social Work

Schedule: Monday-Friday 8:00-4:30pm CST

Facility: Prime Healthcare – Saint Mary of Nazareth Hospital

Location: 2233 W Division St, Chicago, IL 60622 | Free Parking Available

The Medical Review Analyst serves as a specialized subject matter expert (SME) responsible for the analysis, implementation, and optimization of proprietary authorization and utilization management technologies within the hospital setting. This role applies advanced clinical, regulatory, and technical knowledge to evaluate medical documentation practices, authorization workflows, and utilization management processes, ensuring alignment with federal, state, and accreditation standards including CMS, HIPAA, Inter Qual, Milliman Care Guidelines, Joint Commission, and state-specific requirements.

Leads onsite assessments, supports system implementation and integration with existing EMR platforms, and provides technical and clinical guidance to various stakeholders, including the hospital leadership. Responsible for reviewing complex medical records to assess documentation quality, severity of illness, medical necessity, and compliance, translating clinical and operational requirements into system specifications, analyzing utilization data, and supporting reporting and governance needs. Provides technical leadership throughout all phases of implementation, including requirements gathering, testing, go-live, and post-implementation optimization, while serving as a key liaison between clinical teams, revenue cycle, business office, project management, and hospital administration.

Education, Experience, Training

Required Qualifications

• Medical Graduate, Dental Graduate, PA, or Nursing Graduate required.
• Two years of Utilization Review experience.
• Milliman and Inter Qreview experience
• Technical experience in Digital transformation-based tools for healthcare revenue cycle.

Preferred Qualifications

• Strong knowledge of US healthcare operations, payor policies and reimbursement
• Masters in health care.
• Clinical experience in acute care setting preferred.
• Excellent written and verbal communication skills. Excellent critical thinking skills.
• Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.
• Ability to work independently in a time-oriented environment.
• Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred.

Saint Mary of Nazareth Hospital 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 $34.65 to $50.18.

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.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here:

Full Time

Days

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.

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