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Utilization Reviewer, Behavioral Health
Location
Florida + 6 moreAll locations: Florida | Illinois | Iowa | Ohio | Michigan | Missouri | Wisconsin
Posted
5 days ago
Salary
$37 - $52 / hour
Seniority
Mid Level
Job Description
Utilization Reviewer, Behavioral Health
Northwestern Medicine
• 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.
Job 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
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