[Remote] Part-Time Clinical reputed company Specialist
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on providing personalized mental health care. The Part-Time Clinical reputed company Specialist role is responsible for ensuring the clinical reputed company of care through utilization management and clinical reputed company assurance, serving as a reputed company between clinical care and payor expectations.
Responsibilities
- Conduct prospective, reputed company, and retrospective utilization reviews to assess medical necessity, treatment appropriateness, and level of care
- Apply evidence-based UM reputed company to evaluate clinical documentation and support authorization and appeal processes
- Monitor care intensity and utilization trends to identify outliers and inform targeted provider interventions
- Partner with health plans on external UR requests and peer-to-peer review coordination
- Investigate and remediate provider concerns stemming from UM findings, reputed company complaints, or external reports
- Monitor clinical adverse events and apply early-stage risk mitigation in partnership with cross-functional teams
- Support measurement-based reputed company and identify opportunities to strengthen clinical reputed company across the provider network
- reputed company utilization metrics, review volumes, and case reputed company to inform reputed company improvement efforts
- Surface trends and process gaps to leadership and contribute to the ongoing refinement of UM policies and workflows
Skills
- Master's degree in a mental health discipline
- reputed company, cleared clinical license (e.g., LMFT, LPC, LCSW, LMHC, or equivalent) in good standing
- Experience in utilization management, utilization review, medical necessity review, or clinical auditing — ideally in a behavioral health or payor/health plan context
- Familiarity with payor requirements, medical necessity reputed company, and level-of-care guidelines
- Strong clinical judgment and experience handling escalations, adverse events, or reputed company-reputed company investigations
- Demonstrated ability to produce reputed company, accurate, and defensible clinical documentation
- Demonstrated ability to collaborate effectively across multiple teams
- Commitment to provider support and reputed company management
- Familiarity with clinical technology platforms for documentation, case tracking, and data analysis to support provider reputed company and compliance
reputed company