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Peer Review Clinical Specialist

Lighthouse Behavioral Health Solutions
Location
Columbus, Ohio
Posted
16 days ago
Department
Clinical
What they actually want (must-haves)
  • Master's degree in Social Work, Counseling, Behavioral Health, or related clinical field
  • Active and unrestricted Ohio independent behavioral health license (LISW or LPCC)
  • Minimum of three (3) years of behavioral health clinical experience
  • Strong knowledge of ASAM Criteria and level-of-care decision making
  • Ability to assess medical necessity and interpret complex clinical information
  • Strong clinical judgment and critical-thinking skills
Nice to have
  • LISW-S or LPCC-S designation
  • Experience conducting peer-to-peer reviews
  • Prior utilization management, utilization review, or managed care experience
  • Experience working with Medicaid Managed Care Organizations, Medicare, and commercial insurance plans
  • Knowledge of payer medical necessity criteria and authorization processes
What the job really is

The Peer Review Clinical Specialist at Lighthouse Behavioral Health Solutions is responsible for representing the organization in peer-to-peer clinical reviews with various payers. This role involves reviewing clinical documentation, evaluating medical necessity, and collaborating with clinical teams to support authorization requests. Additionally, the Specialist monitors authorization outcomes and identifies trends to improve clinical performance and documentation standards.

Benefits
  • Paid time off (PTO and sick time)
  • Paid holidays
  • Medical/dental/vision
  • 401(k)
  • Life insurance
  • Paid continuing education with supervision
Things to weigh
  • Role focuses heavily on peer-to-peer reviews and may not involve direct patient care
  • No salary listed in the posting
  • Position does not include responsibility for authorization submission, billing, claims processing, or reimbursement
Job score3.2/5
Benefits4/5
Freshness4/5
Career value4/5
Role clarity4/5
Pay transparency0/5

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