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Weekend Therapy Clinical Reviewer Jobs in Springfield, MA

Gandara

In-Home Therapy Clinician | Holyoke

Holyoke, MA · On-site

$60K - $64K/yr

Clinical Licensing Support $1,500 Sign on Bonus! Job Title: In-Home Therapy Clinician Work Location ... Review/development of a risk management/safety plan in collaboration with the youth and parent ...

Lifepoint Health

Clinical Program Therapist

Holyoke, MA · On-site

$62K - $84K/yr

This includes conducting individual, group, and family therapy sessions; participating actively in ... utilization review-to ensure high-quality, patient-centered care. Why join us We believe that ...

Lifepoint Health

Clinical Program Therapist

Holyoke, MA · On-site

$58K - $78K/yr

Reviews charts in preparation of patient treatment planning and provides input on patient progress ... Serve on weekend assessments, group therapy rotation, and clinical-on-call rotation when needed.

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Weekend Therapy Clinical Reviewer information

What is the difference between Weekend Therapy Clinical Reviewer vs Weekend Therapy Case Manager?

AspectWeekend Therapy Clinical ReviewerWeekend Therapy Case Manager
CredentialsLicensed therapist or clinician, often with clinical certificationsLicensed social worker or counselor, with case management certification
Work EnvironmentReviewing clinical documentation, assessing treatment plansCoordinating patient care, managing cases, communicating with providers
Employer & IndustryHealthcare providers, mental health clinics, insurance companiesHealthcare organizations, mental health agencies, insurance companies

The Weekend Therapy Clinical Reviewer primarily evaluates clinical documentation and treatment plans, focusing on quality and compliance. In contrast, the Weekend Therapy Case Manager manages patient cases, coordinates care, and ensures service delivery. Both roles require relevant licensure and work within healthcare or mental health settings, but their core responsibilities differ significantly.

What is a weekend therapy clinical reviewer?

A Weekend Therapy Clinical Reviewer is a licensed mental health professional who evaluates clinical documentation and treatment plans over weekends to ensure patients are receiving appropriate care. They review cases for medical necessity, compliance, and adherence to established guidelines, often for insurance companies or healthcare organizations. Their assessments help determine if continued therapy services are justified, supporting quality care while managing costs.

What are the key skills and qualifications needed to thrive as a weekend therapy clinical reviewer?

To thrive as a Weekend Therapy Clinical Reviewer, you typically need a valid clinical license (such as RN, LCSW, LPC, or LMFT), strong clinical assessment abilities, and a solid understanding of behavioral health guidelines. Familiarity with utilization review software, electronic medical records (EMRs), and knowledge of insurance authorization processes are essential. Excellent communication, attention to detail, and sound judgment are crucial soft skills for effectively reviewing cases and collaborating with providers. These competencies ensure accurate, timely clinical reviews that support patient care and compliance with regulatory standards, especially during off-peak hours.

What are some common challenges faced by weekend therapy clinical reviewers and how can they be managed?

Weekend Therapy Clinical Reviewers often navigate fast-paced decision-making, especially when handling urgent cases or high volumes of clinical documentation within tight deadlines. Balancing thorough case review with efficient turnaround is key, as is maintaining clear communication with therapy providers who may also work non-traditional hours. To manage these challenges, reviewers can stay organized with structured workflows, utilize digital tools for documentation, and proactively clarify questions with supervisors or team members. Being adaptable and staying current with clinical guidelines also supports accuracy and confidence in recommendations.
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Weekend Therapy Clinical Reviewer jobs near you
Infographic showing various Weekend Therapy Clinical Reviewer job openings in Springfield, MA as of August 2026, with employment types broken down into 3% As Needed, 71% Full Time, 18% Part Time, and 8% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

Medicare Clinical Appeals Reviewer III

St. George Tanaq Corporation

Hartford, CT • On-site

Other

Posted 18 days ago

Job description

Medicare Clinical Appeals Reviewer III

Fully Remote-United States

Job Type

Full-time

Description

Overview

Tanaq Support Services (TSS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology, and other government services. TSS is a subsidiary of the St. George Tanaq Corporation, an Alaskan Native Corporation (ANC) committed to serving Federal customers while also giving back to the Tanaq native community and shareholders.

About the Role

We are seeking a Medicare Clinical Appeals Reviewer III (Dispute Resolution Reviewer III) to support our federal client. The Medicare Clinical Appeals Reviewer III is a licensed clinician who independently evaluates complex Medicare appeals and dispute cases, reviews clinical documentation, interprets federal regulations, and issues appeal determinations supported by medical evidence and policy.

They will also provide independent second-level determinations and dispute resolutions based on documentation, facts, laws, regulations, and applicable guidelines. This role works under general supervision with moderate latitude for initiative and independent judgment.

This is a remote position. Candidates must be based in the United States and able to work Eastern, Central, or Mountain Time Zone business hours with availability to work on a rotating schedule on weekends and holidays.

Required: Active, unrestricted license in good standing as an RN, PT, RT, OT, or other qualifying licensed healthcare professional. Licenses with restrictions or encumbrances are not eligible.

Responsibilities

  • Review the medical records/case file, write a reconsideration/dispute resolution decision that is clear, concise, and impartial, supports the determination made, and documents the review.

  • Make fair, impartial, and independent decisions based on current medical evidence, statutes, regulations, rulings, policies, and procedures.

  • Respond to and ensure that all appeal/dispute issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.

  • Conduct research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to make an accurate, well-supported decision.

  • Stay abreast of changes in regulations, medical and healthcare practices, policies, and procedures.

  • Participate in case-specific verbal discussions.

  • Conduct reviews of appeals/disputes involving multiple beneficiaries/services in a single case.

  • Plan responses to statistical analysis challenges with assistance from statisticians.

  • Attend meetings and participate in workgroups at management's direction.

  • Serve as a subject matter expert.

  • Mentors and/or trains staff.

  • Conduct quality reviews and audits, as needed.

  • Participate in special projects and perform other duties as assigned.

Requirements

Required Experience and Skills

  • Must have 2-3 years of experience in medical dispute resolution, Medicare appeals, medical review, clinical review, or a related healthcare setting.

  • Must have Nursing, Physical Therapy, Respiratory Therapy or Occupational Therapy experience. Licensed candidates with closely related clinical or medical experience may be considered.

  • Demonstrated experience writing or making appeal or payment determinations

  • Experience using Microsoft 365, including Excel and Word.

  • Must be able to pass Federal and state criminal background checks, as required by client.

  • Must be able to pass education, certification and license verification, as well as other professional background checks, as required by client.

  • Must be able to pass drug screen, as required by client.

  • Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Preferred Qualifications

  • Medicare appeals, medical review, healthcare compliance review, or independent dispute resolution.

  • Experience making determinations on appeals, payments, billing, or dispute resolution.

  • Experience working with or supporting a federal public health agency environment.

  • Patient-Provider Dispute Resolution or Independent Dispute Resolution experience.

  • Coding certification.

Education and Training

  • Must be an actively licensed healthcare professional with Nursing, Physical Therapy, Respiratory Therapy, Occupational Therapy, or closely related clinical experience.

Physical Requirements

  • Prolonged periods of sitting at a desk and working on a computer. May need to lift 25 pounds occasionally.

Who We Are

Tanaq Support Services (TSS) is a public health contractor and certified 8(a) business owned by St. George Tanaq Corporation, an Alaska Native Corporation (ANC). We listen to our stakeholders and leverage our science, technology, communication, and program expertise to develop effective solutions.

Our commitment to non-discrimination

Tanaq Support Services is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to disability, protected veteran status, or any other status protected by applicable federal, state, or local law. Tanaq complies with the Drug-Free Workplace Act of 1988 and participates in E-Verify.

If you are an individual with a disability and need assistance completing any part of the application process, please email accommodation@tanaq.com to request a reasonable accommodation. This email is for accommodation requests only and cannot be used to inquire about the status of applications.

Notice on candidate AI usage

Tanaq is committed to ensuring a fair and competitive interview process for all candidates based on their experience, skills, and education. To protect the integrity of the interview process, candidates may not use artificial intelligence (AI) tools to generate or assist with responses during phone, in-person, or virtual interviews. Candidates who require a reasonable accommodation that may involve AI must contact us before their interview at accommodation@tanaq.com.

To view this and all our job postings, visit us at:

https://recruiting.paylocity.com/recruiting/jobs/All/a4712c9f-f074-40e8-9a14-bee06660bd81/Tanaq-Support-Services-LLC

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