Clinical Specialist Jobs

About The Position

Requirements

• Minimum of 3 years of clinical experience in the mental health field.
• Proficiency in Microsoft Word, PowerPoint, and Excel, including data entry, formulas, and pivot tables.
• Ability to handle confidential information with discretion.
• Strong knowledge of behavioral health practices, quality improvement standards, regulatory requirements, compliance, and Health Information Management processes.
• Strong analytical and problem-solving skills, including reviewing and interpreting data, identifying trends, defining problems, establishing facts, and developing recommendations.
• Ability to develop, implement, monitor, and evaluate quality and performance improvement initiatives.
• Strong attention to detail, sound judgment, confidentiality, and personal integrity.
• Positive attitude, commitment to superior service, and enthusiastic support of the agency’s mission.
• Ability to collaborate effectively with staff, leadership, and departments across the organization.
• Valid driver’s license, reliable transportation, and ability to meet agency driving requirements.
• Required CPI certification within 90 days of hire.
• Must be at least 21 years of age.

Nice To Haves

• Bachelor’s degree in a mental health-related field, business management, or health care administration; an associate’s degree with relevant experience may be considered.
• Experience in Quality Improvement or process improvement.
• Licensure as an LSW, LPC, LISW, LPCC, or RN.

Responsibilities

• Review clinical documentation and prepare summaries supporting initial and ongoing prior authorization requests.
• Collaborate with Billing to ensure authorization requests are complete, submitted within required timeframes, and followed through to final determination.
• Monitor and track authorization approvals, denials, expiration dates, requested and approved units, and required follow-up.
• Track authorization denials and appeals, including outcomes and trends, and help gather documentation and supporting information for appeals.
• Maintain working knowledge of authorization requirements, processes, timelines, and documentation standards across Medicaid managed care plans and other payers.
• Maintain and analyze authorization, denial, appeal, turnaround-time, and payer-trend data to identify challenges, monitor performance, and support process improvement.
• Build working relationships with clinical leaders and staff to obtain and clarify information and ensure documentation supports requested services.
• As capacity allows, assist with chart reviews and utilization review activities concerning documentation, medical necessity, service utilization, and payer requirements.
• Identify recurring documentation gaps, payer concerns, and process barriers, and collaborate with clinical leadership, Billing, and Quality Improvement to develop and implement solutions.
• Support monitoring of service delivery trends and ongoing quality improvement efforts.
• Educate and guide clinical staff on documentation practices, regulatory compliance, and quality standards.

Benefits

• Paid time off starting at 16 days per year.
• Medical coverage with federal minimum deductibles.
• Dental coverage.
• Vision coverage.
• Retirement planning and employer contribution.