Peer Review Specialist

2 days ago

Philippines Remote Raven Full time ₱120,000 - ₱132,000 per year

Position Summary

We are seeking a highly skilled and detail-oriented Peer Review Specialist 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 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 (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 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.

Requirements

This is a full time job

100% Remote

$10-$11/hr

  • Clinical Care Review Specialist

    2 weeks ago

    Philippines Medva Full time ₱1 - ₱2 per year

    About the RoleWe're looking for a Clinical Care Review Specialist to join our growing healthcare support team. This role plays a vital part in improving patient outcomes through thoughtful clinical review, identifying care gaps, and collaborating with providers and care management teams. If you're a seasoned clinician who thrives on structured work, critical...

  • Utilization Review Specialist

    2 days ago

    Philippines Remote Raven Full time ₱1,200,000 - ₱2,400,000 per year

    The Utilization Review Specialist is responsible for managing all aspects of the utilization review process, including preauthorization, Single Case Agreements (SCA), continued authorizations, and collaboration with clinical staff to ensure documentation meets insurance requirements. This role is crucial in securing necessary authorizations for various...

  • BPO Clinical Review Senior Specialist

    7 days ago

    , Metro Manila, Philippines NTT DATA North America Full time

    NTT DATA seeks a BPO Clinical Review Senior Specialist to join our team in Manila, Philippines. Roles and Responsibilities Provides guidance on preparing case reviews for Medical Directors by researching appeals, reviewing criteria, and analyzing the basis for the appeal. Ensures timely review, processing, and response to appeals in accordance with state,...

  • Nuclear Physics Specialist

    2 days ago

    Philippines Invisible Agency Full time $104,000 - $780,000 per year

    Are you a nuclear physics expert eager to shape the future of AI? Large‑scale language models are evolving from clever chatbots into powerful engines of scientific discovery. With high‑quality training data, tomorrow's AI can democratize world‑class education, keep pace with cutting‑edge research, and streamline lab work for scientists everywhere....

  • Tagalog Language Specialist

    2 days ago

    Philippines Invisible Agency Full time $8,000 - $65,000 per year

    Are you a Tagalog language expert eager to shape the future of AI? Large-scale language models are evolving from clever chatbots into powerful engines of linguistic discovery. With high-quality training data, tomorrow's AI can democratize world-class education, keep pace with cutting-edge research, and streamline communication for Tagalog speakers...

  • Nuclear Engineering Specialist

    2 days ago

    Philippines Invisible Agency Full time ₱8,000 - ₱65,000 per year

    Are you a nuclear engineering expert eager to shape the future of AI? Large‑scale language models are evolving from clever chatbots into powerful engines of scientific discovery. With high‑quality training data, tomorrow's AI can democratize world‑class education, keep pace with cutting‑edge research, and streamline lab work for scientists...

  • Synthetic Chemistry Specialist

    2 days ago

    Philippines Invisible Agency Full time ₱400,000 - ₱3,000,000 per year

    Are you a synthetic chemistry expert eager to shape the future of AI? Large‑scale language models are evolving from clever chatbots into powerful engines of scientific discovery. With high‑quality training data, tomorrow's AI can democratize world‑class education, keep pace with cutting‑edge research, and streamline lab work for scientists...

  • Drug Discovery Specialist

    2 days ago

    Philippines Invisible Agency Full time $8,000 - $65,000 per year

    Are you a drug discovery expert eager to shape the future of AI? Large‑scale language models are evolving from clever chatbots into powerful engines of scientific discovery. With high‑quality training data, tomorrow's AI can democratize world‑class education, keep pace with cutting‑edge research, and streamline lab work for scientists everywhere....

  • Mechanical Engineering Specialist

    2 days ago

    Philippines Invisible Agency Full time $8,000 - $65,000 per year

    Are you a mechanical engineering expert eager to shape the future of AI? Large‑scale language models are evolving from clever chatbots into powerful engines of scientific discovery. With high‑quality training data, tomorrow's AI can democratize world‑class education, keep pace with cutting‑edge research, and streamline technical work for engineers...

  • Environmental Science Specialist

    2 days ago

    Philippines Invisible Agency Full time $8,000 - $65,000 per year

    Are you an environmental science expert eager to shape the future of AI? Large‑scale language models are evolving from clever chatbots into powerful engines of scientific discovery. With high‑quality training data, tomorrow's AI can democratize world‑class education, keep pace with cutting‑edge research, and streamline environmental analysis for...