Care Review Clinician
Are you a seasoned Care Review Clinician seeking a fulfilling role in a reputable organization?
Your search ends here!
We are a leading healthcare organization in Illinois, preferably in the Chicago metro area, seeking an experienced Care Review Clinician. You will be part of a dynamic team, ensuring optimum outcomes, cost-effectiveness, and compliance with all state and federal regulations and guidelines.
This role is 100% remote with a typical schedule/shift from M-F 7am-4pm CST or 8am-5pm CST (with 1-hour lunch; if only taking a 30 min meal break can adjust time accordingly by 30 minutes).
What you’ll be doing…
- Evaluating inpatient services for members to ensure optimum outcomes, cost-effectiveness, and compliance with all state and federal regulations and guidelines.
- Assessing clinical service requests from members or providers against evidence-based clinical guidelines.
- Identifying appropriate benefits, eligibility, and expected length of stay for requested treatments and/or procedures.
- Conducting inpatient reviews to determine financial responsibility for our organization and its members.
- Processing requests within required timelines.
- Collaborating with multidisciplinary teams to promote our Care Model.
- Adhering to UM policies and procedures.
The right person has…
- A Nursing Degree with RN licensure or a Master’s Degree in Social Work, Psychology, or other Behavioral Health field with clinical licensure (i.e. LCSW, LCPC).
- 3+ years of Behavioral Health hospital acute care/medical experience.
- Active, unrestricted State license in good standing, such as RN, LCSW, LPCC/LCPC, or LMFT.
- Attention to detail – especially important for both reviews being completed but also to ensure HIPAA compliance when communicating determinations and other information with facilities.
- Proficiency in the use of Microsoft Office applications.
- Ability to work with multiple monitors and in multiple applications to complete reviews.
Additional Preferred Skills:
- Familiarity with medical necessity criteria (i.e. MCG criteria, ASAM criteria).
- Experience with Behavioral Health and Substance Use Disorder (SUD) diagnoses and treatments.
- MCO and/or UM Experience.
Interested? Contact us directly to learn more!
blueStone Staffing Solutions brings top talent to some of the most desired companies on a contract, contract-to-hire and direct hire basis. We take pride in presenting our candidates with great opportunities they may not have exposure to elsewhere. By working with blueStone, you’ll have access to rewarding job opportunities, competitive compensation, and industry leading benefits packages. We look forward to helping you land your next career opportunity and achieve your goals!