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

Role Description

Acentra Health is looking for a PRN Clinical Reviewer - Substance Use (LPCC, LMFT, LICSW) 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.

• The role is PRN (as needed).
• The role is remote within the United States but requires an active Minnesota license or ability to obtain one within 6 months of accepting an offer.
• It follows standard business hours, with a preference for candidates in the Central Time Zone.

Responsibilities:

• Review and interpret patient records against American Society of Addiction Medicine (ASAM) criteria to determine medical necessity and appropriateness of care.
• Attend training and scheduled meetings and maintain current/updated information for review.
• Assure accuracy and timeliness of all applicable review type cases within contract requirements.
• Assess, evaluate, and address daily workload and queues; adjust work schedules daily to meet the workload demands of the department.
• In collaboration with Supervisor, responsible for quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Maintain current knowledge base related to review processes and clinical practices related to the review processes.
• Function as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.
• Foster 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.
• The above list of responsibilities 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

• 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)
• If the selected candidate does not currently hold an active, unrestricted LPCC, LMFT, or LICSW license in Minnesota, they must be eligible for and able to obtain the required licensure within six months of accepting an offer.
• 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 and abstraction, terminology, and disease processes.
• Strong clinical assessment capabilities paired with excellent critical thinking.
• 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

• 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.