Illinois Licensed Utilization Reviewer

Job Summary

Working part-time in a remote capacity, the Illinois Licensed Utilization Reviewer will manage utilization review calls for 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, discharge reviews, and retrospective appeals
• Collaborate with clinical staff and physicians to communicate patient status and advocate for patients with insurance and managed care companies
• Monitor and appeal unfavorable utilization review decisions, coordinating with the Utilization Review Coordinator and other staff as needed

Required qualifications

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