Medical Reviewer

• Evaluate assessments and make determinations regarding individuals' needs for additional supports and services
• Conduct quality control reviews of field assessors' work to ensure accuracy and compliance
• Review routine service requests, including admissions, discharges, and continued stays, using established clinical criteria, state and federal policy, and contract requirements
• Escalate complex or non-standard cases outside defined protocols
• Issue approvals, denials, or recommendations based on contract requirements and standardized decision frameworks
• Identify needs for additional clinical documentation or consultation and seek guidance from senior staff
• Complete timely and accurate documentation of review activities in contract systems
• Communicate with providers, individuals and their designees, or state workers
• Write substantiated clinical determination reports by synthesizing assessment findings, interview data, and supporting documentation, including summaries of findings
• Support the Illinois SALT program and assessment processes for PASRR Level I screens and Level II SMI evaluations

Medical Reviewer jobs in Illinois

Clinical Reviewer