Clinical Peer Review Specialist

1 week ago

Barcelona, Philippines beBeeProfessional Full time $10,000 - $11,000

We are seeking a highly skilled Peer Review and Clinical Case Consultant

to join our team. This individual will be responsible for conducting peer reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.

The ideal candidate will have a deep understanding of behavioral health documentation and insurance requirements, as well as excellent communication skills and the ability to represent clinical information clearly and persuasively.

Key Responsibilities:
  • Conduct comprehensive chart reviews prior to peer reviews, including progress notes, psychiatric evaluations, history and physical exams, nursing assessments, and medical vitals.
  • Collaborate with clinical and medical 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, including ASAM, MCG, and InterQual.
  • Accurately document all authorization and review interactions in electronic medical records.
  • 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.
  • Ensure adherence to HIPAA, ethical standards, and payer requirements during reviews and documentation.

Requirements:

  • Licensed clinical or medical professional with a minimum of 2 years' experience in behavioral health, substance use, or psychiatric care.
  • Prior experience with utilization review, case management, or insurance authorization processes is strongly preferred.
  • Familiarity with insurance platforms and payer-specific guidelines is essential.
  • Strong attention to detail and ability to work independently and under pressure.
Preferred Qualifications:
  • Nurse Practitioner (NP), Medical Doctor (MD/DO), Licensed Therapist (LCSW, LPC, LMFT, PsyD, PhD)

This role offers a unique opportunity to make a meaningful impact in the field of behavioral health.

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