Clinical Peer Review Coordinator

1 day ago

Angeles City, Central Luzon, Philippines beBeeBehavioral Full time $10 - $11
Job Title:

Peer Review Specialist

About the Role:

This role supports Residential, PHP, and IOP levels of care by conducting peer reviews, case consultations, and interfacing with insurance payers. The ideal candidate is a licensed clinical or medical professional familiar with behavioral health documentation and insurance requirements.

Main Responsibilities:
  • Conduct thorough peer reviews and clinical case consultations to secure continued stay authorizations.
  • Review client charts before peer reviews, including progress notes, psychiatric evaluations, and medical records.
  • Collaborate with the clinical team to gather updated information supporting medical necessity for continued care.
  • Maintain knowledge of insurance criteria (ASAM, MCG, InterQual) and accurately document authorization interactions in the EMR.
  • Participate in interdisciplinary team meetings and provide feedback on documentation practices.
Required Qualifications:
  • Licensed Registered Nurse (RN)
  • Nurse Practitioner (NP), Medical Doctor (MD/DO), Licensed Therapist (LCSW, LPC, LMFT, PsyD, PhD)
  • Minimum 2 years' experience in behavioral health or psychiatric care.
  • Familiarity with insurance platforms and payer-specific guidelines.

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