
Senior Clinical Review Coordinator
4 hours ago
We are seeking a detail-oriented Clinical Review Specialist to support our programs of care.
- This individual will be responsible for conducting clinical reviews, case consultations, and interfacing with 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 payer requirements.
- Conduct clinical reviews and case consultations with payers to secure continued stay authorizations.
- Review comprehensive client charts prior to clinical 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 payer 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.
- Full-time position available
- 100% Remote work option
- Strong attention to detail and ability to work independently and under pressure.
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