Insurance Clinical Liaison (LVN)

Insurance Clinical Liaison (Therapist or LVN)

Position Summary

The Utilization Review / Insurance Clinical Liaison supports the treatment program by compiling and communicating clinical information from the medical record to insurance providers to obtain and maintain authorizations for care. This role requires strong clinical understanding, excellent computer/EMR skills, and polished verbal and written communication to deliver accurate, timely clinical updates that support medical necessity and continued stay.

Key Responsibilities

• Review the medical record (assessments, progress notes, nursing notes, treatment plans, psychiatric/medical documentation, labs/UDS, discharge planning notes) to identify key clinical data needed for authorizations.
• Prepare and deliver clinical presentations to insurance utilization management teams via phone and/or portal submissions.
• Communicate medical necessity and continued stay indicators (e.g., risk factors, withdrawal/psychiatric symptoms, functional impairments, engagement in treatment, step-down barriers).
• Draft and submit concise, well-written clinical summaries and continued stay requests in alignment with payer requirements and program documentation.
• Track authorization dates, level of care approvals, concurrent review schedules, and deadlines; ensure timely submission to prevent gaps in coverage.
• Coordinate with clinical and nursing teams to obtain missing documentation, clarify clinical details, and ensure notes support the authorization request.
• Document all payer communications, decisions, and next steps in the EMR and/or tracking logs.
• Assist with appeals and peer-to-peer coordination when authorization is denied or reduced, including compiling supporting clinical materials.
• Maintain compliance with HIPAA and internal policies regarding PHI, documentation standards, and payer communication.

Required Qualifications

• Licensed Vocational Nurse (LVN) (active license/registration in the relevant state).
• Working knowledge of behavioral health and/or SUD treatment settings (detox, residential, PHP, IOP, outpatient).
• Strong computer skills and comfort navigating EMRs (e.g., KIPU or similar) and payer portals.
• Excellent verbal communication skills—able to present clinical information clearly and professionally on the phone.
• Strong writing skills—able to create accurate, concise, and clinically appropriate summaries.
• High attention to detail, strong time management, and ability to manage multiple deadlines.

Preferred Qualifications

• Prior experience in Utilization Review (UR), Concurrent Review, Case Management, or Insurance Authorization in behavioral health/SUD.
• Familiarity with ASAM Criteria and level-of-care documentation.
• Experience handling denials, appeals, and peer-to-peer coordination.
• Knowledge of documentation standards that support medical necessity and continued stay.

Skills & Competencies

• Clinical judgment and ability to synthesize chart information into a cohesive clinical narrative
• Professional phone presence and de-escalation skills when navigating payer processes
• Organization, follow-through, and strong documentation habits
• Team collaboration with nursing, therapists, providers, and program leadership
• Discretion and strict confidentiality with PHI

Work Environment / Schedule

• Setting: Community-Based Outpatient Facility
• Schedule: Full-time -time; Monday - Friday (9 am - 5 pm)
• On-site