Utilization Management Clinical Consultant

Integrated Resources Inc.; Downers Grove (IL); On-site; USD 80,000 - 110,000; Full time

Job summary

A premier staffing firm seeks a Utilization Management Clinical Consultant to enhance healthcare delivery. The role involves using clinical expertise to guide care management strategies, ensuring compliance with medical necessity guidelines. Candidates should have a solid background in clinical settings and relevant licensing.

Qualifications

• 3-5 years clinical practice experience in hospital or alternative care.
• Managed care/utilization review experience preferred.

Responsibilities

• Coordinate and document all aspects of utilization/benefit management program.
• Evaluate and facilitate appropriate healthcare services/benefits for members.
• Communicate with providers to facilitate optimal care.

Skills

Clinical skills

Critical thinking

Clinical experience

Knowledge of medical necessity criteria

Education

Licensed independent Behavioral Health clinician

Registered Nurse (RN) with unrestricted state license

Job description

• Full-time

Company Description

Integrated 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 Description

The position Title is for a Utilization Management Clinical Consultant. ( RN or LCSW only)

Job Description:
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.

Position Summary/Mission
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.

Fundamental Components & Physical Requirements include but are not limited to
(* denotes essential functions)

• 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(*)
• Exhibits the following Manager Behaviours

Qualifications

Performance 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
Licensed independent Behavioral Health clinician in state of service or a Registered Nurse (RN) with unrestricted state license.

Additional Information

Life Science Recruiter

Integrated Resources, Inc.

DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549