HEIDS Reviewer - Full-time / Part-time

  HEDIS Reviewer needed in Downers Grove, IL

Integrity Staffing Solutions is currently seeking a HEDIS Reviewer in the Downers Grove area. Integrity Staffing Solutions provides comprehensive professional level staffing services on a nationwide basis and has been bringing companies and professionals together almost 20 years. At Integrity Staffing Solutions, we find the best, highest paying professional level positions within the top companies in the area. Most of the positions we identify will never be found in a newspaper or online because of the exclusive relationships we have with our clients who trust Integrity Staffing Solution’s recruiting team to identify top talent to fill their critical hiring needs. Finding a top paying job at a great company is often like signing the contract of a lifetime; let us get to work for you today!   

• Evaluation of Members:

-Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.

- Coordinates and implements assigned care plan activities and monitors care plan progress.

 

• Enhancement of Medical Appropriateness and Quality of Care:

- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.

- Identifies and escalates quality of care issues through established channels.

-Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.

- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

-Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

-Helps member actively and knowledgably participate with their provider in healthcare decision-making.

 

• Monitoring, Evaluation and Documentation of Care:

- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

 

• Exhibits the following Case Management Coordinator Behaviors

-Candidate must exhibit the following skills: -excel with organization and time management skills -self-motivated and independent -adaptable to change -positive attitude

 

This position is based out of the Downers Grove office however the caseload would be located in Cook/Suburban Cook area.

 

Background/Experience Desired

• Managed Care experience preferred

• Case management and discharge planning experience preferred

• 2 years’ experience in behavioral health, social services or appropriate related field equivalent to program focus

 

Education and Certification Requirements

Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).

 

Additional Information:

• Hours: Full Time
• Pay: $27.45
• Employment Type: Contract
• Limited medical and dental coverage for contractors and their families available immediately
• Opportunities for professional growth.

Integrity Staffing Solutions is an Equal Opportunity Employer. All job offers are contingent upon the successful completion of a background check and drug screen.

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