Utilization Review Clinician Behavioral Health Payor Liaison

Clarity Clinic; Chicago (IL); On-site; USD 75,000 - 110,000; Full time

Job summary

Clarity Clinic is a multidisciplinary private practice in Chicago seeking an Utilization Review Clinician. The role oversees clinical utilization review, including prior authorization, concurrent and continued stay reviews, peer-to-peer reviews, and first level appeals across higher levels of care.

The clinician applies clinical training to interpret records against payor criteria, ensuring authorizations and accurate documentation while meeting payor deadlines and regulatory requirements.

Qualifications

• 2+ years of post-licensure clinical experience in behavioral health.
• Working knowledge of payor medical necessity criteria such as LOCUS, CALOCUS, MCG, InterQual, or payor criteria.
• Working knowledge of HIPAA and MHDDCA confidentiality requirements.
• Proficiency in Microsoft 365 (Outlook, Word, Excel, Teams).

Responsibilities

• Review clinical documentation against payor medical necessity criteria before submission and request additions.
• Prepare and submit prior authorization and precertification for admission to PHP, IOP, TMS, Esketamine, testing.
• Track determinations and follow up daily until a decision is issued; escalate delays.
• Document authorization numbers, dates and units in AdvancedMD.
• Conduct concurrent and continued stay reviews for active higher level of care.
• Interpret progress notes to build the medical necessity case for continued treatment.
• Monitor authorization expirations and renew reviews to prevent lapses.
• Communicate level of care changes and status to the treatment team, Intake and Billing.
• Conduct peer-to-peer reviews with payor reviewers; brief clinicians on criteria.
• Prepare and submit first level appeals within the payor window.
• Log adverse determinations and notify relevant teams; maintain audit ready records.
• Ensure compliance with HIPAA and privacy policies; disclose minimum necessary information.

Skills

Behavioral health experience

Payor criteria knowledge

HIPAA knowledge

Microsoft 365 proficiency

Deadline management

Job description

Clarity Clinic is a multidisciplinary private practice in Chicago seeking an Utilization Review Clinician. The role oversees clinical utilization review, including prior authorization, concurrent and continued stay reviews, peer-to-peer reviews, and first level appeals across higher levels of care.

The clinician applies clinical training to interpret records against payor criteria, ensuring authorizations and accurate documentation while meeting payor deadlines and regulatory requirements.