Peer Review Advocate

2 days ago

Taguig, National Capital Region, Philippines beBeeCaregiver Full time $36,960 - $44,120

Job Description:

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The Peer Review Specialist plays a vital role in ensuring the highest quality of care for our clients. This individual will conduct thorough reviews of client charts, including progress notes, psychiatric evaluations, and medical histories, to determine medical necessity for continued care.

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Key Responsibilities:

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  • 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, and medical histories.">
  • 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, such as ASAM, MCG, and InterQual.">
  • Accurately document all authorization and review interactions in the EMR or designated systems.">
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Required Skills and Qualifications:

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This position requires a minimum of 2 years' experience in behavioral health, substance use, or psychiatric care. A licensed Registered Nurse (RN) is the minimum requirement, but a Nurse Practitioner (NP), Medical Doctor (MD/DO), or Licensed Therapist (LCSW, LPC, LMFT, PsyD, PhD) is preferred.

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Candidates should have strong communication skills, excellent attention to detail, and the ability to work independently and under pressure. Familiarity with insurance platforms and payer-specific guidelines is also essential.

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Benefits:

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This is a full-time job with 100% remote work opportunities. The ideal candidate will be motivated, self-directed, and able to work effectively in a virtual environment.

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Others:

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Seniority level: Mid-Senior level

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Employment type: Full-time

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Job function: Administrative

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Industry: Hospitals and Health Care

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