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

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in utilization review processes, including precertification and appeals, while effectively communicating with clinical staff and insurance companies to advocate for patient care. Holds relevant certifications and licenses to support clinical assessments and patient management.

Highest-signal resume keywords

Utilization ReviewPatient AdvocacyManaged Care ContractingClinical AssessmentsInsurance Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization Review CallsPrecertificationContinued Stay ReviewDischarge ReviewsRetrospective ReviewsPatient Benefit InformationAppeals CoordinationClinical Assessments

Soft Skills

CommunicationCollaborationAdvocacy

Certifications & Qualifications

BLSCADCCSADCCPCLCSWMSWRN

Industry Keywords

Health Care Benefit PlansManaged CareInsurance CompaniesClinical StaffBusiness Office Staff

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