Expert Peer Review Consultant
2 days ago
We are seeking a skilled and detail-oriented professional to support our care facilities. This individual will conduct peer reviews, case consultations, and interface with insurance payers to secure continued authorization.
Main Responsibilities- Conduct thorough peer reviews and clinical case consultations with insurance providers.
- Review comprehensive client charts prior to peer reviews, including progress notes, psychiatric evaluations, and medical reports.
- Collaborate with clinical and medical team members to gather updated information that supports the client's medical necessity for continued care.
- Maintain knowledge of insurance medical necessity criteria and accurately document all interactions in designated systems.
- Participate in regular team meetings and provide feedback on documentation practices.
- Track authorization timelines and expirations to avoid service interruptions.
- Licensed Registered Nurse (RN) or higher qualification preferred.
- Minimum 2 years' experience in behavioral health, substance use, or psychiatric care.
- Familiarity with insurance platforms and payer-specific guidelines required.
This is an excellent opportunity for a dedicated professional to make a positive impact in the lives of our clients.
What We OfferWe provide a supportive work environment and opportunities for growth and development.
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