[Hiring] Behavioral Health Clinical Reviewer @Acentra Health, LLC

Role Description

Acentra Health is looking for a Behavioral Health Clinical Reviewer to join our growing team. The purpose of this position is to conduct administrative and process-based reviews of medical records related to Applied Behavior Analysis (ABA) services. The BCBA Clinical Reviewer evaluates documentation against established criteria and contractual requirements to determine medical appropriateness. This role does not involve direct clinical judgment regarding patient care or therapeutic decisions. Instead, the focus is on ensuring compliance, accuracy, and completeness of ABA documentation in accordance with applicable guidelines.

• Conduct prospective reviews of Behavioral Health services, with a focus on Applied Behavior Analysis (ABA)
• Evaluate age-appropriate testing, evaluation, and assessment tools to determine the appropriateness of ABA therapy
• Ensure accuracy and timeliness of all review types in accordance with contract requirements
• Monitor and manage daily workload and review queues, adjusting schedules as needed to meet departmental demands
• Collaborate with the Supervisor on quality monitoring activities, identifying areas for improvement and supporting implementation efforts
• Maintain current knowledge of review processes, clinical practices, and relevant guidelines
• Serve as the first-line reviewer for ABA prior authorization requests, based on workload needs
• Act as a liaison and resource for providers, addressing client/patient service issues and facilitating problem resolution
• Foster positive, professional relationships with internal and external stakeholders to support effective review processes
• Participate in training sessions and scheduled meetings to stay updated on review protocols and industry standards
• Adhere to all corporate policies, including those related to HIPAA Privacy and Security Rules

Qualifications

• Master’s degree in psychology, Behavior Analysis, or another relevant field is required
• 4+ years of experience in Applied Behavior Analysis (ABA) or a related clinical field
• Certification as a Board-Certified Behavior Analyst (BCBA)
• Strong clinical assessment and critical thinking skills
• Medical record abstracting skills
• Knowledge of the organization of medical records, medical terminology, and disease process

Requirements

• Excellent written and verbal communication skills
• Ability to collaborate with families and other medical professionals
• Utilization review and/or case management experience (preferred)
• Medicaid/Medicare/Commercial experience (preferred)
• Understanding of ABA principles, clinical practices, and therapeutic techniques

Benefits

• Comprehensive health plans
• Paid time off
• Retirement savings
• Corporate wellness
• Educational assistance
• Corporate discounts
• And more