Key Responsibilities:

Communicate with third-party payers/patients (or their representatives) and our programs.
Manage pre-authorization requests and concurrent reviews of clinical documentation.
Collaborate with clinical and medical staff to determine appropriate care levels and ensure documentation supports these decisions.
Follow up on authorization determinations, denials, appeals, and complaints.

Qualifications:
Minimum of 2 year in clinical or medical settings, preferably in substance abuse treatment (detox, residential, PHP, IOP).
Ability to analyze medical records, make decisions on admissions/continued stays, and proficiency in documentation.
Familiarity with ASAM criteria or MCG guidelines, strong communication and interpersonal skills.
Has experience in Utilization Review

We offer an hourly rate of 7 USD and provide paid vacation leaves as well as US holidays.

If you don’t have any experience in Behavioral Science/Substance Abuse, please DO NOT APPLY.

Job Type: Full-time

Application Question(s):

• Do you have experience working in clinical or medical experience do you have in substance abuse treatment? Please elaborate. (detox, residential, PHP, or IOP)
• Do you have experience applying ASAM criteria or MCG guidelines in clinical decision-making?
• Are you experienced in reviewing medical records and performing utilization review, including documenting admissions and continued stay decisions?
• How many years of experience do you have working in clinical or medical settings specifically related to substance abuse treatment?

Work Location: Remote