[Hiring] Clinical Reviewer @Acentra Health, LLC

Role Description

Acentra Health is looking for a Clinical Reviewer - Arkansas Behavioral Health License - Full-time (Remote within Arkansas) to join our growing team.

The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.

• Completes prior authorization, continued stay, and retroactive and retrospective quality reviews for Inpatient and Outpatient Behavioral Health Providers.
• Collaborates with the Clinical Director and Team Supervisor to:
  • Monitor provider trends
  • Review government-funded behavioral health program utilization activities
  • Recommend internal policies, procedures, and processes
• Collaborates with Team Supervisor and Medical Director to determine Medical Necessity of services.
• Serves as a resource for Behavioral Health providers.
• Assists Provider Relations Specialist with program-specific education and training.
• Maintains client privacy, confidentiality, and safety at all times.
• Ensures adherence to ethical, legal, and accreditation/regulatory standards.

Qualifications

• Hold an active, unrestricted Arkansas Independent licensure in Social Work, Counseling, or Psychology issued by the Arkansas Social Work Licensing Board, Arkansas Board of Examiners in Counseling and Marriage & Family Therapy, or Arkansas Psychology Board in good standing, in one of the following:
  • LCSW, LMSW
  • LMFT
  • LAC, LPC
  • LPE, LPE-I
• A Behavioral Health Master's degree from an accredited college or university in a related field.
• 2+ years of experience in a behavioral health setting, conducting utilization reviews or behavioral health case management.
• Ability to handle HIPAA confidential information with discretion.
• Skilled in interfacing with multiple providers across various settings.
• Strong knowledge of:
  • Medical, psychiatric, and psychological terminology
  • Mental health assessment tools and treatment plans
  • Delivery of behavioral health services across acute inpatient, and outpatient home and community settings
  • Familiarity with government-funded behavioral health programs, including their policies and procedures.
• Excellent interpersonal skills for building rapport with physicians, behavioral health providers, and family members.
• Highly responsible, self-motivated, and detail-oriented with strong listening, verbal, and written communication skills.
• Solid clinical skills for assessing services based on clinical record reviews.
• Excellent written and verbal communication skills.

Requirements

• Experience with Child and Adolescent Behavior.
• Experience in Utilization Review (UR) and Utilization Management (UM) within behavioral health or medical settings.
• Clinical quality review experience, including the evaluation of medical records.
• Familiarity with medical necessity review criteria specific to Arkansas Medicaid.
• In-depth knowledge of Arkansas Medicaid behavioral health policies and procedures.
• Proficient in automated review systems and Microsoft Office Suite.

Benefits

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