Utilization Management Clinical Consultant
Company: Integrated Resources Inc.
Location: Downers Grove
Posted on: January 21, 2023
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Job Description:
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
Keywords: Integrated Resources Inc., Downers Grove , Utilization Management Clinical Consultant, Healthcare , Downers Grove, Illinois
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