Reviewer

• In-person interview may be required during the hiring process
• Manage relationships with internal and external customers/vendors

MD Appraisal Reviewer managing automobile appraisals at Mercury Insurance

MD Appraisal Reviewer

MD Appraisal Reviewer managing automobile appraisals at Mercury Insurance. Collaborating with internal and external teams to ensure efficient processes and accurate valuations.

• 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.

Utilization Reviewer managing behavioral health utilization within Northwestern Medicine

Utilization Reviewer, Behavioral Health

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

• Responsible for utilization review calls within BHS
• Advocate for BHS patients with insurance and managed care companies
• Communicates insurance input to physicians and clinical staff
• Assists clinical staff with assessments as needed
• Communicates daily with Utilization Review Coordinator
• Understands health care benefit plan provisions and managed care contracting

Utilization Reviewer managing health care assessments and insurance communications

Utilization Reviewer – Behavioral Health

Utilization Reviewer managing utilization review calls and advocating for behavioral health patients. Collaborating with clinical staff and insurance companies, ensuring patient care quality.

Reviewer jobs in Illinois

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MD Appraisal Reviewer

Utilization Reviewer, Behavioral Health

Utilization Reviewer – Behavioral Health