Case Reviewer

Oak Brook, IL · Hybrid · Full-Time · TCP

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About the role

Nursing

As a Case Reviewer, you will be responsible for performing utilization review to authorize services for individuals enrolled in Medicaid. The utilization review process involves applying program policies, verifying medical, technical, and financial eligibility, and reviewing medical records to issue decisions regarding pre-authorization of services. The Illinois Tailored Care Management Program helps individuals with complex health and social needs transition from nursing facilities and Specialized Mental Health Rehabilitation Facilities (SMHRFs) to community-based living. Through person-centered care management and coordinated support services, the program empowers members to live more independently and thrive in their communities.