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Utilization Management Non Clinical Jobs in Illinois

UHS

DIR - UTILIZATION REVIEW / MGMT

Springfield, IL · On-site

$37.55 - $56.33/hr

A clinically skilled multidisciplinary team works to partner with the youth and family to ... The Director of Case Management (Utilization Management) is responsible for the leadership ...

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Utilization Management Non Clinical information

What is the difference between Utilization Management Non Clinical vs Utilization Review Nurse?

AspectUtilization Management Non ClinicalUtilization Review Nurse
CredentialsCertifications like CCM, RN (optional), but primarily non-clinical certificationsRN license, certifications such as CCM or CUC
Work EnvironmentOffice-based, administrative setting, telecommuting optionsClinical settings, hospitals, or insurance companies, often with direct patient or provider interaction
Employer & Industry UsageHealth insurance companies, managed care organizationsHospitals, insurance companies, healthcare providers
Search & Comparison IntentUnderstanding non-clinical roles in utilization managementClinical review roles involving direct patient care assessment

Utilization Management Non Clinical roles focus on administrative, policy, and documentation tasks without direct patient care, while Utilization Review Nurses perform clinical assessments to determine care necessity. Both roles are essential in healthcare utilization but differ mainly in clinical involvement and required credentials.

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Utilization Management Non Clinical jobs near you

Utilization Management Clinical Consultant

Downers Grove, IL

Integrated Resources INC
Recruiting and Staffing Services • 51 - 200 employees
Learn more about Integrated Resources INCexternal

Full-time

Re-posted 7 days ago

Job description

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

Riya Khem

Life Science Recruiter 

Integrated Resources, Inc.

IT Life Sciences Allied Healthcare CRO

Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I

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



Integrated Resources logo

About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996

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