Clinical Reviewer of Behavioral Health

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra Health is looking for a Clinical Reviewer of Behavioral Health to join our growing team. Job Summary: The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness.

• *This position is remote within the United States but must work Eastern time zone.

Responsibilities:

• 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 the initial resource to nurse reviewers regarding all review process questions and/or concerns
• Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution
• Performs all applicable review types as workload indicates
• 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
• Attends training and scheduled meetings and for maintenance and use of current/updated information for review
• Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rule

Qualifications

Required qualifications:

• Active and unrestricted license for the State of Virginia as a Registered Nurse (RN) OR Licensed Mental Health Professional (LMHP) such as Licensed Clinical Psychologist (LCP), Licensed Professional Counselor (LPC), Licensed Clinical Social Worker (LCSW), Licensed Substance Abuse Treatment Practitioner (LSATP), Licensed Marriage and Family Therapist (LMFT)
• Associate's degree or higher from an accredited college or university in a related field
• 1+ year of experience in Prior Authorization, Utilization Review, or Utilization Management
• 3+ years of direct experience in a clinical setting or other applicable State clinical experience
• Must be able to work alternating weekends

Preferred qualifications:

• Bachelor's degree or higher from an accredited college or university in a related field
• Knowledge of the organization of medical records, medical terminology, and disease process
• Strong clinical assessment and critical thinking skills
• Requires excellent written and verbal communication skills
• Medical record abstracting skills

Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay range for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.” #LI-AF1 Pay Range USD $28.37 - USD $39.19 /Hr. Apply tot his job Apply To this Job