[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