Behavioral Health Care Specialist

7 days ago

Tanauan, Calabarzon, Philippines beBeeClinical Full time $10,000 - $11,000

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 payors to obtain continued authorization.

Key Responsibilities:
  • Conduct peer reviews and clinical case consultations with insurance payors 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 Skills and Qualifications:
  • Licensed Registered Nurse (RN) with a minimum of 2 years' experience 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.
  • 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:
  • This is a full-time position.
  • 100% Remote.
Details:
  • Seniority level: Mid-Senior level.
  • Employment type: Full-time.
  • Job function: Administrative.
  • Industry: Hospitals and Healthcare.

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