Clinical Reviewer Behavioral Health

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

16h•Remote

About The Position

Acentra Health is looking for a Clinical Reviewer of Behavioral Health to join our growing team. 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 will be expected to work during Eastern time zone.

Requirements

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 weekends if needed (advance notification will be provided)

Nice To Haves

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

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