Prior Authorization Therapist – Partial Hospitalization Program / Access Center

Children's Careers•Omaha, NE

About The Position

The Prior Authorization Therapist serves as a licensed clinician responsible for managing the utilization review and authorization process for patients receiving care within the Partial Hospitalization Program (PHP). This role ensures continuity of care through accurate documentation, clinical justification, and effective communication with payers, treatment teams, and families. The therapist applies clinical expertise to advocate for medically necessary care and supports the interdisciplinary team in aligning treatment goals with payer expectations and evidence-based standards.

Requirements

Master's degree in Social Work, Counseling, Marriage & Family Therapy, or related behavioral health field.
2 years of clinical experience in a behavioral health or psychiatric setting (preferably in partial hospitalization, intensive outpatient, or inpatient care).
Active state licensure (LMHP, LMHP-I, LIMHP, LPC, LCSW, LMFT, or equivalent).

Nice To Haves

Prior experience in utilization review, case management, or managed care preferred.
Strong understanding of medical necessity criteria, payer systems, and utilization management principles.
Excellent clinical documentation and communication skills.
Ability to collaborate effectively within multidisciplinary teams.
Proficiency in EMR systems and familiarity with payer portals.

Responsibilities

Conduct timely and comprehensive clinical reviews for initial, concurrent, and continued stay authorizations for PHP patients.
Collaborate with insurance reviewers to provide clinical justification and ensure authorization for medically necessary services.
Monitor authorized days and proactively initiate reauthorization requests to prevent gaps in care.
Maintain accurate and detailed documentation in the EMR consistent with payer and regulatory standards.
Track utilization metrics and collaborate with leadership to identify authorization trends, payer barriers, and denial patterns.
Participate in interdisciplinary treatment team meetings to review patient progress, discharge planning, and clinical outcomes.
Support therapists and treatment teams in aligning documentation and treatment plans with medical necessity criteria.
Provide consultation and guidance to staff regarding insurance requirements, clinical documentation, and levels of care criteria (e.g., LOCUS, ASAM, InterQual).
Serve as the liaison between the clinical team, revenue cycle, and payer representatives.
Communicate promptly with patients and families regarding insurance coverage, authorization status, and treatment continuation.
Advocate for the clinical needs of patients when negotiating with payers for continued care.
Ensure adherence to state, federal, and payer regulations regarding documentation, confidentiality, and billing compliance.
Participate in audits, quality reviews, and training initiatives to enhance clinical and operational efficiency.
Support the development of policies and procedures related to utilization management and authorization workflows.