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Job Requirements of Care Review Clinician I (IL):
-
Employment Type:
Contractor
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Location:
Chicago, IL (Onsite)
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Care Review Clinician I (IL)
Careers Integrated Resources Inc
Chicago, IL (Onsite)
Contractor
Job Title: Care Review Clinician I (IL)
Schedule: Full-time, Remote (Must work CST hours)
Pay Rate: $37.98/hr (W2)
Location Requirement: Must hold an active Illinois RN license
Work Hours: 8:00 AM – 5:00 PM CST or 9:00 AM – 6:00 PM CST
Work Days: May include weekends/holidays
Must have medical/surgical acute hospital care experience and utilization management (UM) experience.
Key Requirements:
License: Active, unrestricted Illinois RN license
Experience:
Minimum 2 years in acute hospital medical/surgical care
At least 1 year of Utilization Management (UM) experience
Technical Skills:
Proficient with Microsoft Office
Comfortable using multiple monitors and platforms
Preferred (not required):
Knowledge of medical necessity criteria (MCG, ASAM)
Familiarity with inpatient behavioral health and UM
Job Summary:
As a Care Review Clinician, you will review inpatient services to ensure medically appropriate, cost-effective care. Responsibilities include:
Reviewing clinical documentation from facilities for inpatient admissions (medical-surgical & behavioral health)
Performing inpatient utilization reviews and prior authorizations
Determining benefit eligibility and expected length of stay
Collaborating with Medical Directors and multidisciplinary care teams
Ensuring timely documentation and HIPAA compliance
Referring cases to Case Management as needed
Day-to-Day Responsibilities:
Analyze clinical service requests using evidence-based guidelines
Collaborate with hospitals to maintain accurate authorization data
Present cases to Medical Directors for review
Attend weekly team meetings and monthly supervisor check-ins
Ensure state/contractual deadlines are met
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