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Utilization Review Specialist
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Job Description
- Req#: 903203
Employer Industry: Behavioral Health Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Comprehensive medical, dental, and vision benefits through Blue Cross Blue Shield of Illinois
- Short and long-term disability coverage included
- 401K Safe Harbor Match provided
- Paid time off (PTO) along with paid floating holidays and wellness/self-care days
- Collaborative professional growth development environment
What to Expect (Job Responsibilities):
- Complete pre-authorizations, concurrent reviews, and internal utilization review assessments
- Consult with multidisciplinary treatment team members to gather necessary information for concurrent reviews
- Coordinate urgent/expedited appeals and peer-to-peer reviews as necessary
- Serve as a liaison with medical staff to ensure individual cases are reviewed with MDs as needed
- Follow all standard HIPAA, Joint Commission, and employer policies and procedures related to utilization review
What is Required (Qualifications):
- Minimum 2 years of experience with utilization review in a healthcare provider or insurance environment
- Undergraduate college degree or relevant experience required; master's degree in social work or counseling preferred
- Exceptional organizational skills, reliability, and punctuality
- Strong interpersonal and communication skills that respect diverse perspectives
- Proficiency in Microsoft products (Word, Outlook, Excel) and familiarity with EHR systems and insurance provider platforms
How to Stand Out (Preferred Qualifications):
- A problem-solving orientation with eagerness to identify process gaps and implement solutions
- Ability to work independently and seek support when needed
- Experience managing multiple priorities in challenging situations
- Passion for coaching, mentorship, and team development
- Commitment to innovative, research-based programs and community service
#BehavioralHealth #UtilizationReview #HealthcareJobs #CareerOpportunity #DiversityAndInclusion
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