Senior Clinical Authorization & Intake Specialist

Senior Clinical Authorization & Intake Specialist Caritas Care Solutions Lexington, KY Job Details Full-time $50,000 - $65,000 a year 21 hours ago Benefits Health insurance Dental insurance 401(k) Paid time off Vision insurance Qualifications Microsoft Word Appeals Computer operation Microsoft Outlook Phone communication Google Meet Intake Spreadsheets Zoom Word embeddings Case appeal in utilization management Bachelor's degree Clinical data entry Pre-authorization review for utilization management Video conferencing software Case management Utilization management Resource utilization in healthcare Microsoft Teams Human Services Document viewing software Video conferences (communication methods) Insurance claims appeal handling Technical Proficiency Adobe Acrobat Information management Quality data entry Video conferencing systems operation Data analysis software Full Job Description Senior Clinical Authorization & Intake Specialist Position Summary Caritas Care Solutions is seeking an experienced, technology-oriented behavioral health professional to serve as a Senior Clinical Authorization & Intake Specialist. This is a highly specialized, fast-paced position responsible for managing behavioral health service authorizations, payer communications, intake coordination, clinical documentation review, appeals, peer-to-peer review support, and data analysis. The ideal candidate possesses advanced knowledge of behavioral health services, insurance authorization processes, Kentucky Medicaid Managed Care Organizations (MCOs), and utilization management practices. This individual must be capable of conducting professional clinical discussions with insurance representatives, medical directors, care managers, and provider relations departments while maintaining strict compliance with confidentiality standards. This is not an entry-level position. Candidates must demonstrate prior experience and competency in behavioral health authorization management, utilization review, intake coordination, and healthcare technology systems. Who Should Apply This position is designed for experienced behavioral health professionals who possess advanced technical proficiency, strong payer-relations experience, and the ability to independently manage complex authorization, intake, appeals, grievance, and utilization management processes in a fast-paced environment. Candidates seeking entry-level training opportunities may find that this role exceeds the intended scope of their experience Essential Duties and Responsibilities Authorization & Utilization Management Obtain, manage, and track prior authorizations for behavioral health services.

Coordinate authorization requests for:

Psychotherapy Therapeutic Rehabilitation Programs (TRP) Targeted Case Management (TCM) Intensive Outpatient Programs (IOP) Partial Hospitalization Programs (PHP) Other behavioral health wraparound services Review clinical documentation for medical necessity and authorization requirements. Work collaboratively with clinicians to obtain supporting documentation. Monitor authorization status and prevent service disruptions. Manage authorization renewals and concurrent reviews. Coordinate and support peer-to-peer reviews with insurance medical directors and utilization management staff. Prepare and submit appeals, reconsiderations, and grievance documentation when services are denied. Analyze authorization outcomes and identify denial trends. Clinical Intake & Care Coordination Participate in intake and admission processes. Gather and review clinical information to support service placement and authorization decisions. Communicate with patients, families, referral sources, providers, and payer representatives. Assist in identifying appropriate levels of care based upon clinical presentation and payer requirements. Ensure timely processing of referrals and admissions. Kentucky Medicaid & Payer Relations Serve as a liaison with Kentucky Medicaid Managed Care Organizations and commercial insurance carriers. Maintain working knowledge of Kentucky Medicaid behavioral health benefits and authorization requirements. Conduct detailed clinical discussions with payer representatives regarding treatment plans, medical necessity, service continuation requests, and authorizations. Maintain professional relationships with payer utilization management teams. Data Analysis & Reporting Review, analyze, and disaggregate clinical, authorization, and utilization data. Identify authorization trends, denial patterns, service gaps, and performance opportunities. Generate reports related to authorization approvals, denials, appeals, turnaround times, and utilization metrics. Maintain accurate electronic records and documentation. Compliance & Quality Assurance Protect all patient health information in accordance with HIPAA and organizational policies. Maintain complete, accurate, and timely documentation. Monitor compliance with payer, state, federal, and organizational requirements. Participate in quality improvement initiatives. Minimum Qualifications Education Bachelor's degree in Social Work, Counseling, Psychology, Human Services, Healthcare Administration, or a related field required. Preferred Licensure One of the following active Kentucky licenses preferred:

CSW LCSW LPCA LPCC LMFT

Other clinically relevant behavioral health licensure Equivalent behavioral health experience may be considered. Experience Minimum 3 years of experience in behavioral health utilization management, prior authorization, intake, case management, payer relations, or related healthcare operations. Experience working with Kentucky Medicaid MCOs strongly preferred. Experience with appeals, grievances, and peer-to-peer reviews required. Experience supporting individuals with serious mental illness (SMI), severe emotional disturbance (SED), or complex behavioral health needs strongly preferred. Experience in outpatient behavioral health, community mental health, PHP, IOP, or wraparound service environments preferred. Technical Requirements Candidates must demonstrate proficiency in: Availity Electronic Health Record (EHR) systems TherapyNotes (preferred) Microsoft Excel Microsoft Word Microsoft Outlook Microsoft Teams Adobe Acrobat/PDF Zoom and Google Meet platforms Multi-monitor computer environments Data entry and information management systems Ability to efficiently navigate multiple software applications simultaneously is required. Core Competencies Technology Proficiency Demonstrates advanced ability to navigate multiple technology platforms, payer portals, software applications, and electronic health records simultaneously. Clinical Knowledge Understands behavioral health treatment modalities, levels of care, service authorizations, medical necessity criteria, and payer requirements. Communication Possesses exceptional professional written and verbal communication skills, including telephone and virtual meeting etiquette. Analytical Thinking Evaluates clinical and operational data to identify trends, resolve issues, and improve outcomes. Organization Manages multiple priorities, deadlines, and payer requirements in a fast-paced environment. Confidentiality Maintains the highest standards of patient privacy, professionalism, and ethical conduct. Physical & Work Requirements Prolonged computer use. Ability to work efficiently in a high-volume environment. Ability to manage multiple screens and applications simultaneously. Ability to communicate effectively by telephone, video conference, and electronic communication. Demonstrated ability to accurately and efficiently document, process, and manage high volumes of information in a fast-paced, technology-driven environment. About Caritas Care Solutions Caritas Care Solutions is a Kentucky-based nonprofit behavioral health organization dedicated to improving access to quality mental health services for children, adults, and families throughout the Commonwealth. Our mission is to connect individuals with the clinical, community, and supportive services they need to achieve long-term wellness and stability. Through a comprehensive continuum of behavioral health services—including psychotherapy, targeted case management, therapeutic rehabilitation programs, intensive outpatient services, partial hospitalization programs, and community-based supports—we serve individuals with complex behavioral health needs, including serious mental illness (SMI), severe emotional disturbance (SED), and co-occurring conditions. Caritas Care Solutions combines clinical excellence with innovative technology and data-driven care coordination to ensure individuals receive timely, appropriate, and effective treatment. Our team is committed to compassion, accountability, integrity, and measurable outcomes while working collaboratively with patients, families, providers, community partners, and Kentucky Medicaid Managed Care Organizations. As a nonprofit organization, we are driven by service rather than profit. Every team member plays a critical role in expanding access to care and improving the lives of those we serve. Equal Employment Opportunity Caritas Care Solutions is an Equal Opportunity Employer and is committed to fostering a diverse, inclusive, and respectful workplace. Employment decisions are made without regard to race, color, religion, sex, pregnancy, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law. We are committed to creating an environment where all employees are valued and empowered to contribute to our mission. Reasonable Accommodation Caritas Care Solutions is committed to providing reasonable accommodations to qualified individuals with disabilities throughout the application and employment process. Applicants requiring accommodation are encouraged to contact Human Resources to discuss their needs.

Pay:

$50,000.00 - $65,000.00 per year

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person