Apply on Employer Site

Nexus Health Systems · 21 hours ago

Behavioral Health Clinical Reviewer

Houston, TX

Full-time

Onsite

Mid Level

3+ years exp

Nexus Health Systems is seeking a Behavioral Health Clinical Reviewer responsible for evaluating clinical records and referral documentation. This role involves preparing clinical evaluations that meet payer requirements and ensuring admissions decisions are made accurately and efficiently according to regulatory guidelines.

ConsultingHealth CareHospitalNutrition

Responsibilities

Review incoming referral packets, medical and clinical histories, assessments, and related documentation

Determine program appropriateness for behavioral health, autism, intellectual/developmental disabilities, and medically complex cases

Maintain up-to-date knowledge of insurance and Medicaid documentation standards

Draft clinical documentation that addresses payer expectations and anticipates potential questions or objections

Partner with referral sources, families, and internal teams to clarify information and obtain missing documentation

Clearly communicate admission decisions and next steps

Process referrals and evaluations promptly while maintaining clinical accuracy and compliance

Balance efficiency with quality, ethics, and thoroughness

Stay current on behavioral health conditions, neurodevelopmental disorders, and medical complexities

Monitor evolving payer policies, assessment tools, and evidence-based practices

Qualification

Clinical assessmentsBehavioral health experienceClinical licenseEMR systemsInsurance authorizationMulti-taskingWritten communicationInterpersonal skillsAttention to detailCritical thinking

Required

Master's degree in Social Work, Clinical Psychology, Counseling, Applied Behavior Analysis, or a related behavioral health field; or Bachelor's degree in Nursing

Minimum 3 years of clinical experience in behavioral health, developmental disabilities, or autism spectrum disorders

Proven experience writing clinical assessments/evaluations for payer or insurance approval

Familiarity with private insurance and Medicaid authorization processes

Experience collaborating with interdisciplinary clinical teams

Active clinical license (e.g., LCSW, LPC, LMFT, BCBA, RN, Psychologist) OR eligibility to obtain licensure in Texas

Exceptional written communication skills, with ability to draft clear, concise, and persuasive clinical narratives

Strong interpersonal skills with the ability to work compassionately with families, clinicians, and referral partners

High attention to detail and strong critical thinking

Ability to prioritize, multi-task, and meet deadlines in a fast-paced setting

Proficiency with EMR and CRM systems