Payer Relations Clinician (LISW/LPCC) - Utilization Expert

Lighthouse Behavioral Health Solutions; Columbus (OH); On-site; USD 90,000 - 130,000; Full time

Job summary

Lighthouse Behavioral Health Solutions in Columbus, OH is seeking a Payer Relations Clinician (LISW/LPCC) to represent the clinic in payer reviews, assess medical necessity, and support authorization decisions across the care continuum. This full-time, in-person role requires clinical expertise, strong communication, and collaboration with medical leadership.

The position emphasizes monitoring authorization outcomes, trend analysis, and ongoing performance improvement in utilization management,

Qualifications

• Master's degree in a clinical field and licensure in Ohio (LISW/LPCC).
• At least 3 years of behavioral health clinical experience required.
• Strong knowledge of ASAM Criteria and level-of-care decisions.
• Ability to assess medical necessity and interpret complex clinical information.
• Excellent written and verbal communication skills; capable of professional payer discussions.
• Proficiency with EHR systems and data reporting for utilization review.

Responsibilities

• Serve as the organization's primary clinical representative during peer-to-peer reviews with payer representatives.
• Review clinical records and documentation to prepare for peer-to-peer discussions.
• Evaluate medical necessity and appropriate level of care for authorization requests.
• Apply ASAM Criteria and other clinical standards to support treatment recommendations.
• Collaborate with providers and leadership to obtain documentation for payer reviews.
• Document outcomes, payer feedback, and recommendations per procedures.
• Monitor authorization approvals and denials; identify trends to drive quality improvement.
• Summarize data trends and present findings to the VP of Clinical Services.
• Communicate payer review outcomes to stakeholders and participate in related meetings.

Education

Master's degree in Social Work, Counseling, Behavioral Health, or related clinical field

Active and unrestricted Ohio LISW or LPCC license

Minimum of three (3) years of behavioral health clinical experience

Strong knowledge of ASAM Criteria and level-of-care decision making

Excellent written and verbal communication skills

Proficiency with electronic health record (EHR) systems

Job description

Lighthouse Behavioral Health Solutions in Columbus, OH is seeking a Payer Relations Clinician (LISW/LPCC) to represent the clinic in payer reviews, assess medical necessity, and support authorization decisions across the care continuum. This full-time, in-person role requires clinical expertise, strong communication, and collaboration with medical leadership.

The position emphasizes monitoring authorization outcomes, trend analysis, and ongoing performance improvement in utilization management,