Peer Review Specialist

1 day ago

Las Piñas, National Capital Region, Philippines beBeeUtilization Full time $20,000 - $22,000

We are seeking a highly skilled and detail-oriented professional to support our Residential, PHP, and IOP levels of care.

  • This individual will conduct peer reviews, case consultations, and interface 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, psychiatric evaluations, history and physical exams, nursing assessments, and medical vitals.
  • Maintain a working knowledge of insurance medical necessity criteria, such as ASAM, MCG, and InterQual.
  • Accurately document all authorization and review interactions in the EMR or designated systems.
  • Participate in interdisciplinary team meetings and provide feedback on 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 payer requirements during reviews and documentation.
Requirements
  • This is a full-time job.
  • 100% remote work arrangement.
  • The ideal candidate will have a strong background in behavioral health, substance use, or psychiatric care.
  • Prior experience with utilization review, case management, or insurance authorization processes is strongly preferred.
  • Familiarity with insurance platforms and payer-specific guidelines is essential.

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