What are the responsibilities and job description for the Clinical Review Specialist position at Talent Works?
What are we looking for?
We are looking for a Clinical Review Specialist to support utilization management and insurance authorization processes for individuals receiving behavioral health services. In this role, you will verify insurance coverage, collaborate with clinical teams, communicate with payors, and help ensure clients receive timely authorization for treatment throughout their care.
Key Responsibilities
- Verify insurance coverage for clients admitted to evaluation and treatment programs and coordinate alternative funding sources when coverage is unavailable.
- Review clinical records to ensure appropriate levels of care and treatment modalities are being provided.
- Collaborate with clinical staff to support treatment planning and promote best practices in therapeutic care.
- Conduct ongoing utilization management reviews and secure continued authorization from insurance providers and other payors.
- Participate in treatment team meetings to provide updates on insurance authorizations and obtain clinical information needed for continued reviews.
- Monitor authorization trends and identify opportunities to improve utilization management processes.
- Provide training and guidance to clinical teams on documentation requirements and best practices for obtaining insurance authorizations.
- Support the implementation of new clinical programs through education and collaboration with treatment teams.
Qualifications
- Bachelor's degree in Social Sciences, Nursing, or a related field that qualifies for a Washington State Substance Use Disorder Professional (SUDP) credential.
- Minimum of two years of experience in a clinical role within a medical or behavioral health setting.
- Working knowledge of utilization management principles, insurance authorization processes, and levels of care in behavioral health.
Salary : $22 - $33