Clinical Reviewer (ASAM)

Acentra Health; Virginia, McLean (MN, VA); On-site; USD 100,000 - 125,000; Full time

Job summary

An innovative health solutions provider seeks a Clinical Reviewer to enhance health outcomes through meticulous review of medical records. This role involves utilizing clinical expertise to assess patient care appropriateness, ensuring compliance with ASAM criteria and contractual requirements. Join a passionate team dedicated to redefining healthcare standards and improving lives across the nation. With a focus on collaboration and problem-solving, this position offers a dynamic work environment where your contributions will make a significant impact. Embrace the opportunity to grow your career in a supportive and forward-thinking organization.

Benefits

Comprehensive Health Plans

Paid Time Off

Retirement Savings

Corporate Wellness

Educational Assistance

Corporate Discounts

Qualifications

• Must have active clinical license in Minnesota.
• Requires extensive knowledge of ASAM Criteria.

Responsibilities

• Review patient records to determine medical necessity.
• Maintain knowledge of review processes and clinical practices.

Skills

Clinical Assessment

Critical Thinking

Medical Record Abstracting

Communication Skills

Organization Skills

Education

Active unrestricted LPCC, LMFT, or LICSW

3 years direct clinical work

1 year Utilization Review experience

Tools

Microsoft Office 365

SharePoint Lists

Microsoft Power Applications

Job description

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 to join our growing team.

Job Summary:

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.

Responsibilities:

• Review and interpret patient records against 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.
• Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs.
• 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.

Qualifications

Required Qualifications

• Active unrestricted LPCC, LMFT, or LICSW in the State of Minnesota. If not currently licensed in MN, you must be able to do so upon job offer.
• Minimum three years direct clinical work as a mental health professional in a variety of clinical settings
• Minimum of one year Utilization Review and/or Prior Authorization or related experience
• Extensive knowledge of ASAM Criteria and its implementation in the clinical setting
• Knowledge of the organization of medical records, medical terminology, and disease process required.
• Strong clinical assessment and critical thinking skills required.
• Medical record abstracting skills required.
• Requires excellent written and verbal communication skills.
• Attentiveness to deadlines and the ability to prioritize in a fast-paced environment.
• Outstanding organization skills and attention to detail.
• Proficient using Microsoft Office 365 applications; including SharePoint Lists and Microsoft Power Applications

Preferred Qualifications

• Knowledge of medical records, medical terminology, and disease processes required.
• Strong clinical assessment and critical thinking skills required.
• Excellent written and verbal communication skills required.

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.

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."

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

Careers - Acentra Health

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, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Pay Range

USD $33.35 - USD $41.68 /Hr.