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

Role Description

Acentra Health is looking for a (BCBA) 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.

• This position is remote within the United States but based out of Minnesota.
• The schedule is regular business hours in Central Time Zone but there is flexibility.
• Candidates must be eligible to obtain a certification as a Minnesota Licensed Behavioral Analyst (LBA) upon hire.

Responsibilities:

• Conduct prospective, concurrent, and retrospective 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.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

• Master’s degree in psychology, Behavior Analysis, or another relevant field.
• 4+ years of experience in Applied Behavior Analysis (ABA) or a related clinical field.
• Certification as a Board-Certified Behavior Analyst (BCBA).
• Must be eligible to obtain a certification as a Minnesota Licensed Behavioral Analyst (LBA) upon hire.

Requirements

• Excellent written and verbal communication skills and the ability to collaborate with families and other medical professionals.
• Utilization review and/or case management experience.
• Medicaid/Medicare/Commercial experience.
• Understanding of ABA principles, clinical practices, and therapeutic techniques.
• Medical record abstracting skills, including knowledge of medical record organization, medical terminology, and disease processes.
• Excellent organizational skills.
• Strong clinical assessment and critical thinking skills.

Benefits

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