Care Review Clinician I (IL)
Integrated Resources, Inc., Chicago, IL, United States
Overview
Job Title:
Care Review Clinician
Schedule:
Full-time, Remote (Must work CST hours)
Pay Rate:
$37.98/hr (W2)
Location Requirement:
Must hold an active Illinois RN license
Experience:
Must have inpatient medical and inpatient behavioral health experience.
Work Hours:
8:00 AM – 5:00 PM CST or 9:00 AM – 6:00 PM CST
Work Days:
May include weekends/holidays
Job Description
This care review clinician position is for the inpatient team. One remote position – must work CST hours; schedule likely 8am to 5pm CST or 9am to 6pm CST; may need to work weekends/holidays at times and may need to work until 6pm CST at times. Must have an Illinois license – must be an RN. Must have 2+ years of experience. Must have inpatient medical and inpatient behavioral health experience.
Responsibilities
Assess inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Analyze clinical service requests from members or providers using evidence based clinical guidelines.
Identify appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conduct inpatient reviews to determine financial responsibility for clients and/or its members. May also perform prior authorization reviews and/or related duties as needed.
Process requests within required timelines.
Refer appropriate cases to Medical Directors and present them in a consistent and efficient manner.
Request additional information from providers in a consistent and efficient manner.
Make appropriate referrals to other clinical programs, such as Case Management.
Collaborate with multidisciplinary teams to promote Client Care Model.
Adhere to UM policies and procedures.
Qualifications
Completion of an accredited Registered Nurse (RN).
Required Experience: 1-3 years of acute hospital medical/behavioral health experience; 1+ year of Utilization Management.
Required License, Certification, Association: Active, unrestricted State RN license in good standing; IL RN license.
Familiarity with Inpatient Medical, Behavioral Health, and Utilization Management.
Skills: Flexibility, dependability, reliability, good time management, organized, attention to detail (HIPAA compliance), ability to multi-task and work in a fast-paced environment, proficient with Microsoft Office, ability to work with multiple monitors and applications.
Preferred (not required): Familiarity with medical necessity criteria (e.g., MCG, ASAM).
Day-to-Day Responsibilities
Review clinical information received from facilities for Client members admitted for Inpatient Medical-Surgical or Inpatient Behavioral Health.
Collaborate with facilities to ensure authorization and discharge information is up to date and received timely.
Refer/Collaborate with Client Medical Directors on inpatient medical and/or inpatient behavioral health requests.
Collaborate with multidisciplinary team members to address member needs.
Attend weekly team meetings.
Monthly 1:1s with supervisor.
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Job Title:
Care Review Clinician
Schedule:
Full-time, Remote (Must work CST hours)
Pay Rate:
$37.98/hr (W2)
Location Requirement:
Must hold an active Illinois RN license
Experience:
Must have inpatient medical and inpatient behavioral health experience.
Work Hours:
8:00 AM – 5:00 PM CST or 9:00 AM – 6:00 PM CST
Work Days:
May include weekends/holidays
Job Description
This care review clinician position is for the inpatient team. One remote position – must work CST hours; schedule likely 8am to 5pm CST or 9am to 6pm CST; may need to work weekends/holidays at times and may need to work until 6pm CST at times. Must have an Illinois license – must be an RN. Must have 2+ years of experience. Must have inpatient medical and inpatient behavioral health experience.
Responsibilities
Assess inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Analyze clinical service requests from members or providers using evidence based clinical guidelines.
Identify appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conduct inpatient reviews to determine financial responsibility for clients and/or its members. May also perform prior authorization reviews and/or related duties as needed.
Process requests within required timelines.
Refer appropriate cases to Medical Directors and present them in a consistent and efficient manner.
Request additional information from providers in a consistent and efficient manner.
Make appropriate referrals to other clinical programs, such as Case Management.
Collaborate with multidisciplinary teams to promote Client Care Model.
Adhere to UM policies and procedures.
Qualifications
Completion of an accredited Registered Nurse (RN).
Required Experience: 1-3 years of acute hospital medical/behavioral health experience; 1+ year of Utilization Management.
Required License, Certification, Association: Active, unrestricted State RN license in good standing; IL RN license.
Familiarity with Inpatient Medical, Behavioral Health, and Utilization Management.
Skills: Flexibility, dependability, reliability, good time management, organized, attention to detail (HIPAA compliance), ability to multi-task and work in a fast-paced environment, proficient with Microsoft Office, ability to work with multiple monitors and applications.
Preferred (not required): Familiarity with medical necessity criteria (e.g., MCG, ASAM).
Day-to-Day Responsibilities
Review clinical information received from facilities for Client members admitted for Inpatient Medical-Surgical or Inpatient Behavioral Health.
Collaborate with facilities to ensure authorization and discharge information is up to date and received timely.
Refer/Collaborate with Client Medical Directors on inpatient medical and/or inpatient behavioral health requests.
Collaborate with multidisciplinary team members to address member needs.
Attend weekly team meetings.
Monthly 1:1s with supervisor.
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