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Job Requirements of Care Review Clinician I (IL):
-
Employment Type:
Contractor
-
Location:
Downers Grove, IL (Onsite)
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Care Review Clinician I (IL)
Careers Integrated Resources Inc
Downers Grove, IL (Onsite)
Contractor
Job Title: Care Review Clinician I (IL)
Pay Rate: $37.98/hr.on w2
Location: Fully remote Must have an Illinois license - can be LCSW, LPCC/LCPC, LMFT, or an RN.
Duration: 6 months
Job Description:
These care review clinician positions are for the behavioral health team.
2 remote positions - 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 - can be LCSW, LPCC/LCPC, LMFT, or an RN.
Must have 3+ years of experience.
Must have experience with behavioral health and substance use disorder diagnoses/treatments.
Job Summary
•** Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
KNOWLEDGE/SKILLS/ABILITIES
Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Analyzes clinical service requests from members or providers aProductst evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts inpatient reviews to determine financial responsibility for *** and its members. May also perform prior authorization reviews and/or related duties as needed.
Processes requests within required timelines.
Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
Requests additional information from providers in consistent and efficient manner.
Makes appropriate referrals to other clinical programs, such as Case Management.
Collaborates with multidisciplinary teams to promote Client Care Model.
Adheres to UM policies and procedures.
Required Education
Nursing Degree with RN licensure or Master's Degree in Social Work, Psychology, or other Behavioral Health field with clinical licensure (i.e. LCSW, LCPC)
Required Experience
3+ years Behavioral Health hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State license in good standing, such as RN, LCSW, LPCC/LCPC or LMFT.
State Specific Requirements:
IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment.
Master’s Degree in Social Work, Psychology, or other Behavioral Health field, or graduate from an accredited School of Nursing. Active, unrestricted State license in good standing, such as LCSW, LPCC/LCPC, LMFT or RN.
Must Have Skills: Familiarity with Behavioral Health and Substance Use Disorder (SUD) diagnoses and treatments
Flexibility
Dependability
Reliability
Good time Management
Organized
Attention to detail – especially important for both reviews being completed but also to ensure HIPAA compliance when communicating determinations and other information with facilities
Ability to multi-task, focus and work in fast-paced environment
Ability to work efficiently to ensure meeting strict deadlines per our state requirements/contract
Proficient in the use of Microsoft Office applications
Ability to work with multiple monitors and in multiple applications to complete reviews
Preferred, but not required: Familiarity with medical necessity criteria (i.e. MCG criteria, ASAM criteria) and documentation systems (PEGA)
Day to Day Responsibilities: Review clinical received from facilities for Client members who have been admitted for inpatient behavioral health, SUD residential, or SUD subacute detox services
Collaborate with & outreach facilities to ensure authorization information is up to date and clinical information and discharge information are received in a timely manner
Collaborate with Client Psychiatrists on complex reviews, reviews beyond a certain length of stay, and reviews that do not meet medical necessity criteria
Schedule peer reviews between Client psychiatrists and psychiatric providers at facilities for denials (when requested by facility)
Collaborate with multidisciplinary team members (i.e. Psychiatric MDs, Case Management) to ensure member needs are being addressed
Attend weekly team meetings
Monthly 1:1s with supervisor
Required Years of Experience: 3+ years Behavioral Health hospital acute care/medical experience.
MCO and/or UM Experience preferred.
Required Licensure / Education: Active, unrestricted IL State license in good standing, such as LCSW, LPCC/LCPC, LMFT or RN.
Comments for Suppliers:
Pay Rate: $37.98/hr.on w2
Location: Fully remote Must have an Illinois license - can be LCSW, LPCC/LCPC, LMFT, or an RN.
Duration: 6 months
Job Description:
These care review clinician positions are for the behavioral health team.
2 remote positions - 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 - can be LCSW, LPCC/LCPC, LMFT, or an RN.
Must have 3+ years of experience.
Must have experience with behavioral health and substance use disorder diagnoses/treatments.
Job Summary
•** Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.
KNOWLEDGE/SKILLS/ABILITIES
Assesses inpatient services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Analyzes clinical service requests from members or providers aProductst evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts inpatient reviews to determine financial responsibility for *** and its members. May also perform prior authorization reviews and/or related duties as needed.
Processes requests within required timelines.
Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner.
Requests additional information from providers in consistent and efficient manner.
Makes appropriate referrals to other clinical programs, such as Case Management.
Collaborates with multidisciplinary teams to promote Client Care Model.
Adheres to UM policies and procedures.
Required Education
Nursing Degree with RN licensure or Master's Degree in Social Work, Psychology, or other Behavioral Health field with clinical licensure (i.e. LCSW, LCPC)
Required Experience
3+ years Behavioral Health hospital acute care/medical experience.
Required License, Certification, Association
Active, unrestricted State license in good standing, such as RN, LCSW, LPCC/LCPC or LMFT.
State Specific Requirements:
IL Qualifications: Licensed within the state of Illinois or will apply for licensure within the state of Illinois within 30 days of employment.
Master’s Degree in Social Work, Psychology, or other Behavioral Health field, or graduate from an accredited School of Nursing. Active, unrestricted State license in good standing, such as LCSW, LPCC/LCPC, LMFT or RN.
Must Have Skills: Familiarity with Behavioral Health and Substance Use Disorder (SUD) diagnoses and treatments
Flexibility
Dependability
Reliability
Good time Management
Organized
Attention to detail – especially important for both reviews being completed but also to ensure HIPAA compliance when communicating determinations and other information with facilities
Ability to multi-task, focus and work in fast-paced environment
Ability to work efficiently to ensure meeting strict deadlines per our state requirements/contract
Proficient in the use of Microsoft Office applications
Ability to work with multiple monitors and in multiple applications to complete reviews
Preferred, but not required: Familiarity with medical necessity criteria (i.e. MCG criteria, ASAM criteria) and documentation systems (PEGA)
Day to Day Responsibilities: Review clinical received from facilities for Client members who have been admitted for inpatient behavioral health, SUD residential, or SUD subacute detox services
Collaborate with & outreach facilities to ensure authorization information is up to date and clinical information and discharge information are received in a timely manner
Collaborate with Client Psychiatrists on complex reviews, reviews beyond a certain length of stay, and reviews that do not meet medical necessity criteria
Schedule peer reviews between Client psychiatrists and psychiatric providers at facilities for denials (when requested by facility)
Collaborate with multidisciplinary team members (i.e. Psychiatric MDs, Case Management) to ensure member needs are being addressed
Attend weekly team meetings
Monthly 1:1s with supervisor
Required Years of Experience: 3+ years Behavioral Health hospital acute care/medical experience.
MCO and/or UM Experience preferred.
Required Licensure / Education: Active, unrestricted IL State license in good standing, such as LCSW, LPCC/LCPC, LMFT or RN.
Comments for Suppliers:
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