Part-time Clinical Reviewer - Substance Use (LPCC, LMFT, LICSW)

Acentra Health, LLC

12h•$28 - $39•Remote

About The Position

Acentra Health is looking for a Part time 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 contract requirements. The role is part time and 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 an expected schedule of 20 to 30 hours per week, and a preference for candidates located in the Central Time Zone.

Requirements

Active, unrestricted license in the state of Minnesota in one of the following areas: LPCC, LMFT, or LICSW (or ability to obtain 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 experience.
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.
Must attend a Monday orientation (or Tuesday if Monday is a holiday).

Nice To Haves

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.
Located 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.
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.
Attends training and scheduled meetings and for maintenance and use of current/updated information for review.
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.