Care Coordinator

2 days ago

Bacoor, Calabarzon, Philippines beBeeClinical Full time $10 - $11

Job Title: Peer Review Specialist

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  • About the Role:
  • We are seeking a highly skilled and detail-oriented professional 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.

The ideal candidate will be a licensed clinical or medical professional who is deeply familiar with behavioral health documentation and insurance requirements.

Key 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 (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 (e.g., ASAM, MCG, InterQual).
  • Accurately document all authorization and review interactions in the EMR or designated systems.
  • 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 all payer requirements during reviews and documentation.

Required Qualifications:

  • Licensed Registered Nurse (RN) or higher degree holder
  • Minimum 2 years' experience in behavioral health, substance use, or psychiatric care
  • Prior experience with utilization review, case management, or insurance authorization processes preferred
  • Familiarity with insurance platforms and payer-specific guidelines
  • Excellent communication skills with the ability to represent clinical information clearly and persuasively
  • Strong attention to detail and ability to work independently and under pressure

Benefits:

  • Full-time position
  • 100% Remote work arrangement

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