Illinois Licensed Utilization Reviewer

Job Summary

Working remotely on a part-time basis, the Illinois Licensed Utilization Reviewer will manage utilization review calls within Behavioral Health Services, including precertification and discharge reviews, while collaborating with clinical staff and insurance companies to advocate for patient care.

Key responsibilities

• Conduct utilization review calls, including precertification, continued stay reviews, and retrospective appeals
• Collaborate with clinical staff and physicians to communicate patient status and advocate for patients with insurance providers
• Coordinate efforts to appeal unfavorable utilization review decisions and monitor denials

Required qualifications

• 2+ years of experience in utilization review or related field
• Master's Degree in Social Work or Psychology, or a BSN with an RN License