Utilization Reviewer, Behavioral Health

🔥 13 minutes ago

🐊 Florida, Illinois, +5 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🏈 Ohio – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🧀 Wisconsin – Remote

💵 $37 - $52 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

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Northwestern Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🧘 Wellness

💰 $25M Grant on 2018-06

Healthcare Insurance • Pharmaceuticals • Wellness

Northwestern Medicine is a renowned healthcare provider offering a wide range of medical services, including COVID-19 and flu vaccinations, cutting-edge treatments, and pioneering surgical procedures. The organization is deeply involved in clinical research, contributing to significant medical advancements such as exploring the causes of diseases like lupus and breakthroughs in cancer treatment. With a robust network of hospitals and specialized care centers, Northwestern Medicine is dedicated to patient wellness, community impact, and medical education. They emphasize accessibility, patient safety, and convenience through services like telehealth, financial assistance, and multilingual support. Whether it's immediate care, advanced procedures, or multidisciplinary care for complex conditions, Northwestern Medicine is committed to leading the way in healthcare innovation and patient-centered care.

📋 Description

• Responsible for utilization review calls within BHS, including precertification, continued stay review, discharge reviews, and retrospective reviews and appeals. • Works closely with business office staff, clinical staff, and physicians to advocate for BHS patients with insurance and managed care companies. • Communicates insurance input to physicians and clinical staff making discharge plans for patients. • Assists clinical staff with assessments as needed, primarily as in a back-up capacity. • Communicates daily with Utilization Review Coordinator, and as needed with business office and admissions staff to understand admissions and transfers, patient benefit information, and precertification status. • Understands health care benefit plan provisions and managed care contracting. • Communicates and coordinates efforts at appealing unfavorable utilization review decisions.

🎯 Requirements

• 2+ years of experience • Master's Degree in Social Work or Psychology or BSN with RN License • Preferred: BSN with RN License • CERT BLS • CERT CADC • CERT CSADC • LIC CPC • LIC LCSW • LIC MSW • LIC RN

🏖️ Benefits

• Tuition reimbursement • Loan forgiveness • 401(k) matching • Lifecycle benefits