[Hiring] Clinical Reviewer - Substance Use - LPCC, LMFT, LICSW - PRN @Acentra Health, LLC

Role Description

Acentra Health is looking for a Clinical Reviewer - Substance Use - LPCC, LMFT, LICSW - PRN (Remote U.S.) 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 contractual requirements, critical thinking, and decision-making skills to determine medical appropriateness.

Responsibilities:

• Review and interpret patient records against American Society of Addiction Medicine (ASAM) criteria to determine medical necessity and appropriateness of care.
• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
• Assures accuracy and timeliness of all applicable review type cases within contract requirements.
• Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
• In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Maintains current knowledge base related to review processes and clinical practices related to the review processes.
• Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.
• Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

** This is a PRN (as needed) role working during the week Monday through Friday in the time zone where the selected candidate resides. **

Qualifications

• The selected candidate must hold an active, unrestricted license in the state of Minnesota in one of the following areas:
  • LPCC, issued by the Minnesota Board of Behavioral Health and Therapy (BBHT)
  • LMFT, issued by the Minnesota Board of Marriage and Family Therapy (BMFT)
  • LICSW, issued by the Minnesota Board of Social Work (BOSW)
• 3+ years of experience providing direct clinical work as a mental health professional across diverse clinical settings.
• 1+ years of Utilization Review (UR) OR Utilization Management (UM) OR Prior Authorization.
• In-depth understanding of ASAM criteria and its practical application in clinical environments.
• Familiarity with medical records structure, terminology, and disease processes.
• Strong clinical assessment capabilities paired with excellent critical thinking.
• Proficient in medical record abstraction.
• Regardless of work schedule, all new hires must attend a Monday orientation. If Monday is a Company-observed holiday, orientation will be held on Tuesday instead.

Requirements

• Proficiency in Microsoft Office 365 applications, including Word, Excel, Outlook and Teams.
• Excellent written and verbal communication skills.
• Demonstrated ability to manage deadlines, prioritize tasks, and thrive in a fast-paced environment.
• Highly organized with meticulous attention to detail.

Benefits

• This position includes access to select Acentra Health benefits and programs, such as participation in the Acentra Health 401(k) Plan with company match.
• Access to wellness and employee discount programs.
• Employee Assistance Program (EAP) resources.