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Northwestern Medicine

Utilization Reviewer, Behavioral Health

Northwestern Medicine

Utilization Reviewer managing behavioral health utilization reviews at Northwestern Medicine. Focused on precertification, discharge reviews, and advocating for patients with insurance companies.

Posted 7/1/2026part-timeRemote • Florida, Illinois, Iowa, Missouri, Montana, Ohio, Wisconsin • 🇺🇸 United StatesJuniorMid-Level💰 $37 - $52 per hourWebsite

About the role

Key responsibilities & impact
  • 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

What you’ll need
  • 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

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools
Utilization Review CallsPrecertificationContinued Stay ReviewDischarge ReviewsRetrospective ReviewsPatient Benefit InformationAppeals CoordinationClinical Assessments
Soft Skills
CommunicationCollaborationAdvocacy
Certifications
BLSCADCCSADCCPCLCSWMSWRN