Top Healthcare Services Jobs in Chicago, IL

Provide clinical oversight for utilization management and care transitions, perform daily UM reviews and peer-to-peer discussions, liaise with network and community providers, support care coordination and analytics needs, participate in medical advisory activities, and provide intermittent weekend/evening coverage.

Provide clinical oversight for inpatient care management, perform medical necessity and length-of-stay reviews, collaborate with providers and operational partners, apply evidence-based guidelines, support quality initiatives, and participate in rotational call and holiday coverage.

Provide physician oversight for clinical coverage and utilization management in cardiology, conduct pre-service benefit and medical necessity reviews, document findings, engage in peer-to-peer discussions, collaborate with providers and internal teams, and participate in rounds and occasional call/holiday coverage to ensure cost-effective, quality care.

Provide physician oversight for medical claims and coverage determinations in plastic surgery, collaborate with providers and internal teams, document reviews, and participate in utilization management and quality improvement.

Provide physician oversight for clinical coverage and post-service medical necessity determinations for urology cases, document findings, engage in peer-to-peer discussions, collaborate with providers and internal teams, and support quality, cost-effectiveness, and policy interpretation in utilization management.

Provide clinical oversight for utilization management of pain procedures, conduct and document coverage reviews, render determinations, ensure regulatory compliance (CMS/NCQA/URAC), coordinate with clinical staff and treating providers, participate in training, quality improvement, and rotational call coverage.

Provide physician clinical support for medical claims and coverage determinations, perform clinical reviews per benefit plans and policies, document findings, engage in peer-to-peer provider discussions, participate in clinical rounds, and collaborate with multidisciplinary and internal teams to ensure appropriate, cost-effective care for members.

Provide clinical guidance for radiation oncology utilization management, perform case reviews and provider consultations, support quality and cost-effective care initiatives, educate teams, analyze clinical and claims data, participate in client presentations, and provide rotational on-call coverage.

Provide physician clinical review for medical claims and coverage determinations in hematology/oncology, document findings, engage in peer-to-peer discussions, collaborate with providers and internal teams, participate in quality improvement, and ensure cost-effective, evidence-based care consistent with benefit plans and policies.

Provide physician oversight for clinical claims and coverage determinations related to sleep and pulmonology. Conduct benefit and medical necessity reviews, document findings, engage in peer-to-peer discussions with providers, participate in clinical rounds, and collaborate with internal teams to ensure cost-effective, evidence-based member care.