Current jobs related to Utilization Review Clinician - Chicago - Centene Corporation
-
Clinical Utilization Review Specialist
2 days ago
Chicago, Illinois, United States Centene Corporation Full timeJob SummaryWe are seeking a highly skilled Clinical Utilization Review Specialist to join our Medical Management/Health Services team at Centene Corporation. As a key member of our team, you will play a critical role in ensuring the quality and appropriateness of mental health and substance abuse services for our 28 million members.Key...
-
Clinical Utilization Review Specialist
2 weeks ago
Chicago, Illinois, United States Rising Medical Solutions Full timeCompany OverviewRising Medical Solutions is dedicated to transforming the healthcare landscape by enhancing the efficiency of healthcare claims through comprehensive bill review, case management, and utilization review. Position SummaryWe are currently seeking a qualified Utilization Review Nurse to join our team. This full-time role requires a commitment of...
-
Physician Reviewer for Utilization Management
2 weeks ago
Chicago, Illinois, United States Oak Street Health Full timeCompany: Oak Street Health Title: Full-Time Utilization Management Physician Reviewer Location: Remote/ Treehouse Role Overview: This full-time position is dedicated to delivering precise and prompt coverage decisions for both inpatient and outpatient services by utilizing utilization management (UM) criteria, clinical expertise, and established internal...
-
Utilization Management Physician Reviewer
4 weeks ago
Chicago, United States Oak Street Health Full timeDescription Company: Oak Street Health Title: Full-Time Utilization Management Physician Reviewer Location: Remote/ Treehouse Role Description: This full-time role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management (UM) criteria, clinical judgment, and internal...
-
Utilization Management Physician Reviewer
3 weeks ago
Chicago, United States Oak Street Health Full timeCompany: Oak Street Health Title: Full-Time Utilization Management Physician Reviewer Location: Remote/ Treehouse Role Description: This full-time role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management (UM) criteria, clinical judgment, and internal policies and...
-
Utilization Management Physician Reviewer
3 weeks ago
Chicago, United States Oak Street Health Full timeCompany: Oak Street HealthCheck below to see if you have what is needed for this opportunity, and if so, make an application asap.Title: Full-Time Utilization Management Physician ReviewerLocation: Remote/ TreehouseRole Description:This full-time role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient...
-
Utilization Management Physician Reviewer
3 weeks ago
Chicago, United States Oak Street Health Full timeCompany: Oak Street HealthTitle: Full-Time Utilization Management Physician ReviewerLocation: Remote/ TreehouseRole Description:This full-time role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management (UM) criteria, clinical judgment, and internal policies and...
-
Physician Reviewer
5 days ago
Chicago, Illinois, United States Dane Street, LLC Full timeAbout the RoleDane Street, LLC is seeking a Board Certified Internal Medicine physician to conduct Independent Medical Exams (IMEs) and Peer Reviews. As a medical reviewer, you will utilize your clinical expertise to review disability claims and provide an interpretation of the medical appropriateness of services provided by other healthcare...
-
Community Clinician
3 months ago
Chicago, United States Kaleidoscope Full timeJob DescriptionJob DescriptionCommunity Clinician- HybridChicago, ILKaleidoscope is a charitable organization located in Chicago with a mission to enhance child and family wellbeing by delivering innovative, individualized care and strengthening community connections. We are looking to build our Enhanced Clinical Community Support Program and are seeking...
-
Youth Support Clinician
2 weeks ago
Chicago, Illinois, United States Kaleidoscope Full timePosition Overview:Kaleidoscope is a charitable organization dedicated to enhancing the wellbeing of children and families through innovative, individualized care and strengthening community ties. We are currently expanding our Enhanced Clinical Community Support Program and are in search of a dedicated Community Clinician.As part of our commitment to our...
-
Utilization Management Physician Reviewer
3 weeks ago
Chicago, IL, United States Oak Street Health Full timeCompany: Oak Street HealthTitle: Full-Time Utilization Management Physician ReviewerLocation: Remote/ TreehouseRole Description:This full-time role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management (UM) criteria, clinical judgment, and internal policies and...
-
Chicago, Illinois, United States Northwestern Memorial Healthcare Full timeJob SummaryWe are seeking a highly skilled Quality Utilization Specialist to join our team at Northwestern Memorial Healthcare. As a key member of our healthcare team, you will play a critical role in ensuring the highest quality patient care and optimal resource utilization in our Emergency Department.Key ResponsibilitiesApply medical necessity criteria,...
-
Medical Review Specialist
2 weeks ago
Chicago, Illinois, United States Dane Street, LLC Full timeDane Street, LLC, recognized as a certified "Great Place to Work," is actively seeking Board Certified Internal Medicine physicians to engage in Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a conventional Monday to Friday workweek while adhering to client-mandated turnaround...
-
Chicago, United States Northwestern Memorial Healthcare Full timeJob DescriptionJob DescriptionCompany DescriptionAt Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no...
-
Licensed Clinician RHP
2 months ago
Chicago, United States Rush University Full timeJob Description Location: Chicago, IL Hospital: RUSH University Medical Center Department: Road Home Research Admin Work Type: Full Time (Total FTE between 0.9 and 1.0) Shift: Shift 1 Work Schedule: 8 Hr Summary: Road Home Program: The National Center of Excellence for Veterans and Their Families (RHP) is dedicated to assisting and supporting current...
-
Community Clinician
4 weeks ago
Chicago, United States Kaleidoscope Full timeCommunity Clinician- HybridChicago, ILKaleidoscope is a charitable organization located in Chicago with a mission to enhance child and family wellbeing by delivering innovative, individualized care and strengthening community connections. We are looking to build our Enhanced Clinical Community Support Program and are seeking individuals to fill the position...
-
Medical Review Specialist
1 week ago
Chicago, Illinois, United States Dane Street, LLC Full timeDane Street, LLC, recognized as a certified "Great Place to Work," is seeking Board Certified Internal Medicine physicians to perform Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a standard Monday to Friday work week while adhering to client-mandated turnaround times.As a...
-
Medical Review Specialist
2 weeks ago
Chicago, Illinois, United States Dane Street, LLC Full timeDane Street, LLC, recognized as a certified "Great Place to Work," is actively seeking Board Certified Internal Medicine physicians to perform Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a standard Monday to Friday workweek while adhering to client-mandated turnaround times.As...
-
Medical Review Specialist
1 week ago
Chicago, Illinois, United States Dane Street, LLC Full timeDane Street, LLC, recognized as a certified "Great Place to Work," is seeking Board Certified Internal Medicine physicians to perform Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a standard Monday to Friday workweek while adhering to client-mandated turnaround times.As a...
-
Utilization Management Coordinator
4 weeks ago
Chicago, Illinois, United States Universal Health Services, Inc. Full timeResponsibilities Offering $3000 sign-on bonus JOB SUMMARY: Performs timely, daily clinical reviews with all payer types, to secure authorization for initial and continued treatment based on payer's criteria and in accordance with the hospital wide Utilization Management Plan. Serves as liaison to 3rd and 4th party reviewers, effectively coordinating...
Utilization Review Clinician
1 month ago
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
****NOTE: This is a fully remote role for US based applicants with independent clinical licensure. Preference will be given to applicants who reside in either central or eastern time zone with utilization management / review experience as well as experience in mental health settings such as crisis intervention, substance treatment, and inpatient. ****
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.
Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Master’s degree for behavioral health clinicians required.
Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred.
Knowledge of mental health and substance abuse utilization review process preferred.
Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.
License/Certification:
****Additional Details:
• Department: IL Meridian Behavioral Health Utilization Management ****
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
