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Northwestern Medicine

What makes us better, makes you better.

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

Postgraduate Degree2 yrs expEnglish

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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