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Utilization Review Specialist
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Job Description
- Req#: 980333
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
- Paid time off, including floating holidays and wellness/self-care days
- Supportive and collaborative work environment focused on professional development
- Role allows for remote work flexibility
What to Expect (Job Responsibilities):
- Complete pre-authorizations, concurrent reviews, and internal UR reviews
- Consult with multidisciplinary treatment team members to gather required information for 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 appropriately
- Maintain compliance with all applicable regulations and guidelines while supporting organizational goals
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; master's degree in social work or counseling preferred
- Exceptional organizational skills, with a reliable and timely work ethic
- Excellent interpersonal and communication skills, with respect for others' perspectives
- Proficiency in Microsoft products (Word, Outlook, Excel) and familiarity with EHR systems and insurance provider platforms
How to Stand Out (Preferred Qualifications):
- Problem-solving orientation with eagerness to identify process gaps and implement solutions
- Ability to work independently while recognizing the need for support
- Passion for coaching, mentorship, and team development
- Commitment to innovative research-based programs and community service
- Ability to manage multiple priorities and respond confidently in challenging situations
#BehavioralHealth #UtilizationReview #RemoteWork #CareerGrowth #HealthcareBenefits
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