Clinical Professional Specialist

2 days ago

Makati City, National Capital Region, Philippines beBeeClinical Full time $38,400 - $48,000
Job Description

We are seeking a highly skilled and detail-oriented clinical professional to support our residential, PHP, and IOP levels of care. This individual will be responsible for conducting peer reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.

The ideal candidate will be a licensed clinician who is deeply familiar with behavioral health documentation and insurance requirements.

This role involves conducting comprehensive reviews of client charts, including progress notes, psychiatric evaluations, history and physical exams, nursing assessments, and medical vitals.

Key Responsibilities
  • Conduct peer reviews and clinical case consultations with insurance payers to secure continued stay authorizations.
  • Review comprehensive client charts prior to peer reviews, including:
    • Progress notes (individual, group, family sessions)
    • Psychiatric evaluations
    • History and physical exams (H&P)
    • Nursing assessments and daily logs
    • Medical vitals, height, weight, and lab reports
  • Collaborate with clinical team members to gather updated and relevant information that supports the client's medical necessity for continued care.
  • Maintain a working knowledge of insurance medical necessity criteria (e.g., ASAM, MCG, InterQual).
  • Accurately document all authorization and review interactions in designated systems.
  • Participate in interdisciplinary team meetings and provide feedback regarding documentation practices that support utilization review.
  • Proactively track authorization timelines, expirations, and upcoming reviews to avoid service interruptions.
Required Skills and Qualifications
  • Minimum: Licensed Registered Nurse (RN)
  • Preferred: Nurse Practitioner (NP), Medical Doctor (MD/DO), Licensed Therapist (LCSW, LPC, LMFT, PsyD, PhD)
  • Minimum of 2 years' experience in behavioral health, substance use, or psychiatric care.
  • Prior experience with utilization review, case management, or insurance authorization processes strongly preferred.
  • Familiarity with insurance platforms and payer-specific guidelines.
  • Excellent communication skills with the ability to represent clinical information clearly and persuasively.
  • Strong attention to detail and ability to work independently and under pressure.
Benefits
  • This is a full-time job
  • 100% Remote

This is an exciting opportunity for a dedicated and results-driven clinical professional to join our team.

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