"Alerted.org

Schedule: Monday-Friday, 8:00a-4:30p

At Children’s, the region’s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve.

Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview

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.

Essential Functions

+ Utilization Management & Authorization

+ 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.

+ Clinical Coordination

+ 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).

+ Communication & Advocacy

+ 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.

+ Compliance & Quality Improvement

+ 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.

Education Qualifications

+ Master's Degree Master’s degree in Social Work, Counseling, Marriage & Family Therapy, or related behavioral health field. Required

Experience Qualifications

+ 2 years of clinical experience in a behavioral health or psychiatric setting (preferably in partial hospitalization, intensive outpatient, or inpatient care). Required

+ 1 year Prior experience in utilization review, case management, or managed care preferred. Preferred

Skills and Abilities

+ 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.

Licenses and Certifications

+ Active state licensure (LMHP, LMHP-I, LIMHP, LPC, LCSW, LMFT, or equivalent). Upon Hire Required

Children’s is the very best for kids and the very best for your career! At Children’s, we put YOU first so together, we can improve the life of every child!

**Requisition ID** : 23468