What are the responsibilities and job description for the Clinical Supervisor & Utilization Review Specialist position at Highlife Recovery, LLC?
Highlife Recovery is seeking an independently licensed behavioral health clinician to join our Columbus team as a Clinical Supervisor & Utilization Review Specialist.
This position combines clinical supervision, utilization management, and payer coordination. We are specifically looking for someone with strong clinical judgment who is comfortable working with insurance companies, completing prior authorizations, participating in peer reviews, and supporting clinicians with documentation and medical necessity requirements.
The ideal candidate can confidently review a case, identify what is needed to support the recommended level of care, and communicate that rationale effectively to insurance reviewers and other clinicians.
Responsibilities:
- Provide clinical supervision and consultation to assigned clinical staff
- Support clinicians with documentation, treatment planning, medical necessity, and level-of-care decisions
- Complete and support prior authorization and continued-stay authorization requests
- Participate in peer reviews and other payer clinical reviews
- Communicate clinical rationale and medical necessity for recommended services and levels of care
- Review clinical documentation for consistency with authorization and payer requirements
- Identify documentation gaps that may affect authorization or reimbursement
- Assist with utilization review and authorization tracking
- Support appropriate transitions between levels of care
- Participate in interdisciplinary treatment planning and case consultation
- Assist with clinical documentation review, quality improvement, and program development
- Complete assessments, individual therapy, or other clinical services as needed
Qualifications:
- Active Ohio independent social work license required
- LISW-S strongly preferred
- Experience providing clinical supervision strongly preferred
- Experience with behavioral health prior authorizations, utilization review, peer reviews, or payer-facing clinical work strongly preferred
- Experience working with Medicaid managed care organizations and commercial insurance plans preferred
- Experience in substance use disorder and co-occurring mental health treatment preferred
- Strong understanding of medical necessity, level-of-care determinations, and clinical documentation
- Ability to confidently discuss clinical cases with insurance reviewers, physicians, and other healthcare professionals
- Strong written and verbal communication skills
- Ability to provide clear, constructive guidance to clinical staff
We are particularly interested in candidates who have experience on either side of the utilization review process, including clinicians who have conducted payer reviews or regularly responded to authorization and peer-review requests.
Schedule:
Full-time, approximately 40 hours per week.
Location:
Columbus, Ohio
Highlife Recovery provides outpatient substance use disorder and mental health treatment, including individual and group counseling, case management, medication-assisted treatment, and medical and psychiatric services.
Pay: $80,000.00 - $95,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Flexible schedule
- Paid time off
Work Location: In person
Salary : $80,000 - $95,000