Horizon Recovery is hiring a Peer Review Specialist to support our Residential, PHP, and IOP levels of care. You will be responsible for conducting peer reviews, case consultations, and interfacing with insurance payers to obtain continued authorization, ensuring clients receive uninterrupted care.
What You'll Do
- Conduct peer reviews and clinical case consultations with insurance payers to secure continued stay authorizations.
- Review comprehensive client charts prior to peer reviews, including progress notes, psychiatric evaluations, history and physical exams (H&P), nursing assessments and daily logs, and medical vitals, height, weight, and lab reports.
- Collaborate with clinical and medical team members to gather updated and relevant information that supports the client’s medical necessity for continued care.
- Maintain a working knowledge of insurance medical necessity criteria (e.g., ASAM, MCG, InterQual).
- Accurately document all authorization and review interactions in the EMR or designated systems.
- Participate in interdisciplinary team meetings and provide feedback regarding documentation practices that support utilization review.
- Proactively track authorization timelines, expirations, and upcoming reviews to avoid service interruptions.
- Ensure adherence to HIPAA, ethical standards, and all payer requirements during reviews and documentation.
What We're Looking For
- Licensed Registered Nurse (RN).
- Minimum of 2 years’ experience in behavioral health, substance use, or psychiatric care.
- Excellent communication skills with the ability to represent clinical information clearly and persuasively.
- Strong attention to detail and ability to work independently and under pressure.
Nice to Have
- Nurse Practitioner (NP), Medical Doctor (MD/DO), Licensed Therapist (LCSW, LPC, LMFT, PsyD, PhD).
- Prior experience with utilization review, case management, or insurance authorization processes strongly preferred.
- Familiarity with insurance platforms and payer-specific guidelines.
Benefits & Compensation
- Compensation: $10-$11/hr.
Work Mode
This is a global position.
Horizon Recovery is an equal opportunity employer.
