Clinical Review Expert

2 days ago

Antipolo City, Calabarzon, Philippines beBeeExpertise Full time $10,000 - $11,000

Job Summary

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

This individual will be responsible for conducting clinical reviews, case consultations, and interfacing with insurance payers to obtain continued authorization.

Main Responsibilities
  • Conduct thorough clinical reviews and case consultations with insurance payers to secure continued stay authorizations.
  • Review comprehensive client charts prior to clinical reviews, including:
    • Progress notes (individual, group, family sessions)
    • Psychotherapeutic 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
  • Minimum: Licensed Registered Nurse (RN)
  • Preferred: Nurse Practitioner (NP), Medical Doctor (MD/DO), Licensed Therapist (LCSW, LPC, LMFT, PsyD, PhD)
  • Minimum of 2 years' experience in behavioral health, substance use, or psychiatric care.
  • Prior experience with utilization review, case management, or insurance authorization processes 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 job opportunity
  • 100% remote work arrangement

We value candidates who bring expertise and enthusiasm to their work. If you are a licensed professional looking to contribute your skills to this role, we encourage you to apply.

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