
Care Coordinator Specialist
2 days ago
We are seeking a highly skilled and detail-oriented Professional to support our Residential, PHP, and IOP levels of care.
The ideal candidate will be a licensed clinical or medical professional who is deeply familiar with behavioral health documentation and insurance requirements.
This individual will be responsible for conducting reviews, case consultations, and interfacing with payers to obtain continued authorization.
Key Responsibilities- Conduct reviews and clinical case consultations with payers to secure continued stay authorizations.
- Review comprehensive client charts prior to 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 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.
- Accurately document all interactions in the EMR or designated systems.
- Participate in meetings and provide feedback regarding 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.
- 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 processes strongly preferred.
- Familiarity with platforms and payer-specific guidelines.
- Excellent communication skills with the ability to represent information clearly and persuasively.
- Strong attention to detail and ability to work independently and under pressure.
- Seniority level: Mid-Senior level
- Employment type: Full-time
- Job function: Administrative
- Industry: Hospitals and Health Care
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