Clinical Review Specialist
2 weeks ago
This position involves reviewing and assessing patient charts to ensure medical necessity for continued care. The ideal candidate will be a licensed clinical or medical professional with experience in behavioral health documentation and insurance requirements.
Key Responsibilities- Conduct thorough reviews of comprehensive client charts, including progress notes, psychiatric evaluations, and lab reports.
- Collaborate with clinical and medical team members to gather updated information supporting medical necessity.
- Maintain knowledge of insurance medical necessity criteria, such as ASAM and MCG.
- Accurately document all interactions in electronic medical records.
- Participate in team meetings to discuss documentation practices and provide feedback.
- Track authorization timelines and expirations to prevent service interruptions.
We are seeking an experienced professional to join our team in this critical role.
Requirements- Minimum 2 years' experience in behavioral health or psychiatric care.
- Prior experience with utilization review, case management, or insurance authorization processes is preferred.
- Familiarity with insurance platforms and payer-specific guidelines is essential.
- Strong communication and analytical skills are required.
- This is a full-time remote opportunity.
- A competitive hourly rate.
- A dynamic and supportive work environment.
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