Remote Behavioral Health Clinical Reviewer

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

Job summary

Acentra Health, LLC is hiring a Clinical Reviewer to utilize clinical expertise to review medical records against criteria and contract requirements. The role includes prior authorization, continued stay, and quality reviews for behavioral health providers, with collaboration to monitor trends and ensure medical necessity.

Ideal candidates hold an Arkansas license in SW, Counseling, or Psychology, a Behavioral Health Master’s degree, and 2+ years of UR or case management experience.

Qualifications

• Active behavioral health licensure in AR (SW/ counseling/ psychology) in good standing.
• Behavioral health master's degree from an accredited program.
• 2+ years of utilization review or case management experience.

Responsibilities

• Review medical records for prior authorization, continued stay, and quality reviews.
• Collaborate with Clinical Director to monitor provider trends and program utilization.
• Determine medical necessity of services with Medical Director.
• Ensure privacy and compliance with HIPAA and regulatory standards.

Skills

Interpersonal skills

HIPAA privacy

Clinical review

MS Office

Education

Behavioral Health Master's degree

Arkansas licensure (SW/Counseling/Psychology)

Tools

Microsoft Office Suite

Job description

Acentra Health, LLC is hiring a Clinical Reviewer to utilize clinical expertise to review medical records against criteria and contract requirements. The role includes prior authorization, continued stay, and quality reviews for behavioral health providers, with collaboration to monitor trends and ensure medical necessity.

Ideal candidates hold an Arkansas license in SW, Counseling, or Psychology, a Behavioral Health Master’s degree, and 2+ years of UR or case management experience.