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
Location: Downers Grove, IL
Responsibilities:
- Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.
- Develop, implement and support Health Strategies, tactics, policies and programs that ensure the delivery of benefits and 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.
- Utilize 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.
- Utilize 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.
- Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
- Communicate with providers and other parties to facilitate care/treatment.
- Identify members for referral opportunities to integrate with other products, services and/or programs.
- Identify opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
- Consult and lend 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 licensure required.
Additional Information:
- 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 handwritten and computer-generated documents as well as a PC monitor.
- Typical office working environment with productivity and quality expectations.
- Experience in Behavioural 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 (approximately to rotate once every 1 & ½ to 2 months).
- The ability to create and process clinical for Behavioural Health cases on a live phone queue, create and process clinical to of a determination to the provider.
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