What are the responsibilities and job description for the Clinical Review Specialist position at Talent Works?
What are we looking for in a Clinical Review Specialist?
The Clinical Review Specialist verifies client insurance coverage, provides information regarding the client’s treatment to payors as requested and ensures that payors authorize treatment throughout the client’s placement.
Clinical Review Specialist duties may include:
- Verifies initial insurance coverage for each client admitted to an evaluation and treatment facility. Works with BHO’s or other payor sources to verify coverage of placement, if the client does not have coverage.
- Conducts reviews of clinical records to ensure appropriate levels of care and modalities are being provided. Effectively and collaboratively works with clinical staff when challenging the course of treatment and
- therapeutic engagement necessary. Exhibits sound clinical judgment when assisting in the development of the course of treatment.
- Provides ongoing utilization management reviews to authorizing bodies and obtains continued authorization throughout the inpatient placement.
- Attends facility staff meetings via telephone and obtains necessary clinical information, as well as provides information regarding insurance authorization status to the treatment team.
- Routinely monitors and tracks different authorizing bodies to identify patterns of problems and helps to develop plans for improvement.
- Provides training and guidance to treatment teams regarding necessary documentation and language for authorizations.
- Assists in implementing and providing training to new clinical programs in the Residential Treatment, Crisis and Evaluation and Treatment facilities.
Qualifications:
- Bachelor’s degree in social sciences or nursing or as necessary to obtain a Washington State Substance Use Disorder Professional credential.
- Two years of experience in a clinical position in a medical or behavioral health care setting
- Working knowledge of current practices related to levels of care and utilization management concepts.
What We Can Offer You
Training and Development
- A variety of career opportunities in a wide range of settings with room for mobility and promotion
- Regular training opportunities including support, supervision, and consultation in implementing evidence-based services and programs
Innovative Program & Services
- A strong reputation for providing quality, evidence-based services within a collaborative multi-disciplinary team environment
- Innovative, forward-looking leadership that seeks to thrive in an ever-changing healthcare environment
- Joint Commission-accredited organization committed to continuous quality improvement
- Established partnerships with major research universities and other community and healthcare providers to implement cutting-edge treatment programs and services
Excellent Benefits
- Competitive salaries within our communities and industry
- Healthcare coverage for employee and qualified family members
- Generous vacation, paid holiday and sick leave policies
- Access to Employee Assistance Program services
- Agency-funded retirement plan with contributions equal to 5% of compensation
- Additional retirement investment opportunities with a 50% investment match of up to 4% of compensation
- Agency-funded life and disability insurance program
- Financial incentives to further employee education
Salary : $22 - $33