Utilization Management Nurse

Integrated Resources, Inc

Downers Grove, Illinois

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JOB DETAILS

JOB TYPE

Contractor

SKILLS

Behavioral Health, Clinical Competency, Clinical Information, Clinical Medicine, Communication Skills, Compensation and Benefits, Computer Skills, Consulting, Establish Priorities, Healthcare, Licensed Clinical Social Worker (LCSW), Managed Care, Multitasking, Nursing, Options Analysis, Physical Demands, Presentation/Verbal Skills, Process Development, QoS (Quality of Service), Registered Nurse (RN), Team Player, Typing, Utilization Management, Willing to Travel, Writing Skills

LOCATION

Downers Grove, Illinois

POSTED

1 day ago

Utilization Management NurseIntegrated 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 DescriptionJob Title: Utilization Management Nurse ConsultantDuration: 6 months (Possible ext)Location: Downers Grove, ILResponsibilities:· Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.· Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.· Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.· Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN (consideration for LCSW) with unrestricted active license.· Fundamental Components & Physical Requirements include but are not limited to· (* denotes essential functions)· Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members· Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care· Communicates with providers and other parties to facilitate care/treatment· Identifies members for referral opportunities to integrate with other products, services and/or programs· Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization· Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function· Background/Experience Desired· Managed Care experience preferred· 3-5 years of clinical experience required· Education and Certification Requirements· RN consideration for LCSW) with current unrestricted state license required.· Additional Information (situational competencies, skills, work location requirements, etc.)· Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding· Effective communication skills, both verbal and written.· Ability to multitask, prioritize and effectively adapt to a fast paced changing environment· Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.· Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.· Typical office working environment with productivity and quality expectations· Additional for Behavioral Health:· Experience in Behavioral Health required· Managed Care experience preferred.· Onsite location will be Downers Grove.· Work hours from 8:00 am until 5:00 pm with weekend rotation among the team of clinicians (approximated to rotate once every 1 & ½ to 2 months).· The ability to create and process clinical for Behavioral Health cases on a live phone queue, create and process clinical to of a determination to the provider.Additional Job Details :· Required to have computer skills.· Work with-toggle between up to 5-6 applications/systems at a time.· Travel Required: No

Utilization Management Nurse

Integrated Resources, Inc

Downers Grove, Illinois

About the Company

Integrated Resources, Inc

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