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Utilization Management Clinical Consultant - Downers Grove Illinois
Company: Integrated Resources Inc.
Location: Downers Grove, Illinois
Posted On: 10/31/2024
- Full-timeCompany DescriptionIntegrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.Job DescriptionThe position Title is for a Utilization Management Clinical Consultant (RN or LCSW only).Job Responsibilities:
- Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare.
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services.
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care.
- Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage/crisis support).
- Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment.
- Identifies members who may benefit from care management programs and facilitates referral.
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.QualificationsPerformance Measures:Background/Experience Desired:
- 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
- Managed care/utilization review experience preferred.Education and Certification Requirements:
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