
Clinical Care Coordinator
24 hours ago
We are seeking a highly skilled and detail-oriented Peer Review Specialist 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.
Main 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, psychiatric evaluations, history and physical exams, nursing assessments, and medical vitals.
- Collaborate with clinical and medical team members to gather updated information that supports the client's medical necessity for continued care.
- Maintain a working knowledge of insurance medical necessity criteria, such as ASAM and MCG.
- Document all authorization interactions in the EMR or designated systems.
Qualifications:
- Licensed Registered Nurse (RN)
- Nurse Practitioner (NP), Medical Doctor (MD/DO), Licensed Therapist (LCSW, LPC, LMFT, PsyD, PhD) - preferred
- Experience in behavioral health, substance use, or psychiatric care, preferably with utilization review, case management, or insurance authorization processes
This is a full-time job, 100% remote opportunity.
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