- 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
- LCSW- License Clinical Social Worker required or
- LMHC-Licensed Mental Health Counselor required or
- LPC-Licensed Professional Counselor required or
- Licensed Marital and Family Therapist (LMFT) required or
- Licensed Mental Health Professional (LMHP) required or
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
-
Utilization Review Clinician
3 weeks ago
Centene Corporation Chicago, United States Full timeYou 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. ...
-
Pre-Licensed Clinical Social Worker
4 days ago
Psychiatric & Psychological Specialties Chicago, United StatesIntegrative Psychotherapy Training · at Psychiatric and Psychological Specialties · Psychiatric and Psychological Specialties (PPS) is a group private practice of psychiatrists, psychologists, social workers, and professional counselors who work within an integrated mental healt ...
-
Physical Therapist
2 weeks ago
UI Health Chicago, United StatesResponsibilities: Performs the duties of a professional Physical Therapist for an assigned caseload with emphasis on providing comprehensive care. · The PT is responsible for upholding professional standards and promoting quality in practice. · Direct Patient Care time (actual t ...
-
Director of Compliance
3 weeks ago
Addison Group Chicago, United StatesTitle – Director of Compliance · Hours: onsite · Pay: up to $140K · Location: Chicago, IL · Perks: My client has an impressive employee benefits package and provides a strong 401k match and great facilities. They also provide an incredible culture, room for internal growth, and t ...
-
Coding Compliance Specialist ll
1 week ago
Health Care Service Corporation Chicago, United States Full timeAt HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career. · Come join us and be part of a purpos ...
-
Claro, Inpatient Chart Review Specialist
3 weeks ago
Kaufman Hall Chicago, United StatesThe OrganizationWe help society's foundational institutions—healthcare and higher education—to achieve their full potential in service to others.We are our clients' trusted partners in ever-changing times. For more than 30 years, Kaufman Hall has provided independent, objective i ...
-
Flex Emergency Services Admissions RN
3 weeks ago
Foundations for Living Chicago, United States PER_DIEMResponsibilities POSITION SUMMARY: · Focuses primarily on RN-to-RN screenings, (i.e. reviewing H&P, labs, and other clinical documentations) for all admissions and ensures patients are medically appropriate for admission. · Responds to inquiry calls regarding services. · Ov ...
-
Northwestern University Chicago, United StatesThe Department of Physical Medicine and Rehabilitation at Northwestern University Feinberg School of Medicine seeks a full-time non-tenure-eligible Clinician-Educator at the rank of Associate Professor or Professor . · Responsibilities include: · Provide leadership for ...
-
Domestic Violence Specialist
2 weeks ago
Cook County Sheriff's Office Chicago, United StatesGeneral Overview · The Domestic Violence Specialist, under the direction of the Clinical Program Manager, will serve as a clinician for Cook County Sheriff's Office (CCSO), Community Resource Center (CRC). The Domestic Violence Specialist will work with a multidisciplinary team o ...
-
Sr. Disability Representative
3 weeks ago
Sedgwick Chicago, United States Full timeTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
-
Lab Director
2 weeks ago
Apex Systems Chicago, United StatesJob Summary · The Lab Director supervises and manages a manufacturing production team consisting of microbiome process associates and assistants, a quality assurance professional, and bioengineers responsible for performing technical laboratory procedures to support biomanufactur ...
-
Senior Histocompatibility Technologist
1 week ago
The University of Chicago Medicine Chicago, United States FT RegularJob Description · Be a part of a world-class academic healthcare system, UChicago Medicine , as a Senior Histocompatibility Technologist in the Transplant Lab .In this role as a Senior Histocompatibility Technologist, we directly support the UCM Transplant Institute and you ...
-
Clinician
4 days ago
W3R Consulting Chicago, United StatesJob Title – Clinical Quality Research Analyst · Duration – 7 months · Location - Onsite: Chicago Illinois. · Start date: **ASAP** · If you are interested, please forward your current resume to and you can also reach me at to discuss your career aspirations. · Looking forward t ...
-
Program Manager/Analyst
1 week ago
University of Chicago Chicago, United States Full timeDepartment · BSD CCC - Administration About the Department · The University of Chicago Comprehensive Cancer Center (UCCCC) is an integral component of the Biological Sciences Division (BSD). The BSD is the largest of four Divisions of the University and includes the Pritzker S ...
-
Huron Chicago, United States Full timeThe Opportunity · Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead ...
-
Clinical Care Transition Educator
4 weeks ago
Option Care Health Chicago, United StatesExtraordinary Careers. Endless Possibilities. · With the nation's largest home infusion provider, there is no limit to the growth of your career. · Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With ov ...
-
Team Leader
3 days ago
Thresholds Chicago, United States Full timePosting Details · Posted: June 18, 2024 · Full-Time · On-site · Locations Showing 1 location 1110 W Belmont Ave · 1110 W Belmont Ave · Chicago, IL , USA · 1110 W Belmont Ave · 1110 W Belmont Ave · Chicago, IL , USA · Job Details · Description · Thresholds is seeking a skil ...
-
Registered Dietitian
2 weeks ago
Kindred Hospital Chicago Lakeshore Chicago, United StatesDescription · ScionHealth is committed to a culture of service excellence as demonstrated by our employees' adherence to the service excellence principles of Pride, Teamwork, Compassion, Integrity, Respect, Fun, Professionalism, and Responsibility. · As our most acute level of c ...
-
clinical nurse leader
1 week ago
Cook County Health Chicago, United States Full timeJob Summary · The Clinical Nurse Leader (CNL) provides patient care, clinical consultation, mentorship, staff and patient education, policy and education authorship and clinical, research and evidence-based practice expertise within the Department of Nursing. The CNL identifies, ...
-
Senior Product Marketing Manager
2 weeks ago
STERIS Chicago, United StatesAt STERIS, we help our Customers create a healthier and safer world by providing innovative healthcare and life science product and service solutions around the globe. · Position Summary · For over 130 years, V. Mueller has crafted, collaborated and consistently evolved surgical ...
Utilization Review Clinician - Chicago, United States - Centene Corporation
Description
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 CST or EST time zone with experience in mental health settings and utilization management / review. ****
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.
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 ****
Pay Range: $ $44.85 per hour
Pay Range: $ $46.68 per hourCentene 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.