Behavioral Health Utilization Specialist

Northwestern Memorial Healthcare; DeKalb Township (IL); On-site; USD 51,000 - 72,000; Full time

Benefits offered by this job

Tuition reimbursement

Loan forgiveness

401(k) matching

Lifecycle benefits

Hybrid work opportunities

Job summary

Northwestern Medicine seeks a dedicated Utilization Reviewer for Behavioral Health Programs to ensure high-quality documentation, regulatory compliance, and program outcomes across multiple behavioral health services. Responsibilities include concurrent and retrospective reviews, auditing IM+CANS/IATP documentation, and collaborating with leadership to improve performance and compliance.

Fully qualified candidates will have 2+ years in utilization review and a strong grasp of Medicaid and grant

Qualifications

• 2+ years of experience in utilization review, quality assurance, or chart auditing.
• Knowledge of Medicaid/grant regulatory requirements and healthcare payer rules.
• Experience with behavioral health documentation standards is preferred.

Responsibilities

• Conduct concurrent, prospective, and retrospective utilization reviews of clinical records.
• Audit assessments, treatment plans, IM+CANS, IATP, and progress notes for compliance and accuracy.
• Monitor timeliness, completeness, and quality of documentation across programs.
• Collaborate with clinical leaders to improve documentation quality and regulatory outcomes.
• Provide education and support to staff on documentation standards.

Skills

Utilization review

Regulatory compliance

Education

Master's Degree in Social Work or Psychology or BSN with RN License

Tools

EPIC

Job description

Northwestern Medicine seeks a dedicated Utilization Reviewer for Behavioral Health Programs to ensure high-quality documentation, regulatory compliance, and program outcomes across multiple behavioral health services. Responsibilities include concurrent and retrospective reviews, auditing IM+CANS/IATP documentation, and collaborating with leadership to improve performance and compliance.

Fully qualified candidates will have 2+ years in utilization review and a strong grasp of Medicaid and grant