Behavioral Health Utilization Reviewer (Remote, AR)

Acentra Health; Arkansas; Remote; USD 39,000 - 54,000; Full time

Job summary

Acentra Health is seeking a remote Behavioral Health Reviewer to leverage clinical expertise in reviewing medical records against contract criteria, supporting inpatient and outpatient behavioral health services while ensuring medical necessity and Arkansas Medicaid compliance.

The ideal candidate holds an Arkansas license in Social Work, Counseling, or Psychology, a Behavioral Health Master’s degree, and 2+ years of utilization review or case management experience, with strong HIPAA and

Qualifications

• Active, unrestricted Arkansas licensure in Social Work, Counseling, or Psychology in good standing.
• Behavioral Health Master’s degree from an accredited program.
• 2+ years of experience in behavioral health utilization reviews or case management.
• Ability to handle HIPAA confidential information with discretion.

Responsibilities

• Perform prior authorization, continued stay, and retrospective reviews for behavioral health services.
• Ensure accuracy and timeliness of review cases within contract requirements.
• Collaborate with Supervisor/Medical Director to determine medical necessity.
• Maintain knowledge of Arkansas Medicaid policies and regulations.
• Educate and support Behavioral Health Providers on reconsideration and appeal processes.
• Protect client privacy and adhere to ethical, legal, and regulatory standards.

Skills

Behavioral health

Utilization reviews

HIPAA compliance

Interpersonal skills

Medical terminology

Documentation

Education

Behavioral health master's degree

Tools

Microsoft Office

Automated review systems

Job description

Acentra Health is seeking a remote Behavioral Health Reviewer to leverage clinical expertise in reviewing medical records against contract criteria, supporting inpatient and outpatient behavioral health services while ensuring medical necessity and Arkansas Medicaid compliance.

The ideal candidate holds an Arkansas license in Social Work, Counseling, or Psychology, a Behavioral Health Master’s degree, and 2+ years of utilization review or case management experience, with strong HIPAA and