Remote Behavioral Health Clinical Reviewer

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

Benefits offered by this job

Health insurance

Paid time off

Retirement plan

Job summary

Acentra Health, a national leader in health solutions, is seeking a Clinical Reviewer to apply clinical expertise to review medical records against contract criteria. This fully remote role requires Arkansas residency and focuses on prior authorization, continued stays, and quality reviews for behavioral health providers.

Collaborate with leadership to monitor provider trends, ensure medical necessity, and educate providers on reconsideration and appeal processes while upholding privacy, ethics,

Qualifications

• Active, unrestricted Arkansas licensure in Social Work or Counseling or Psychology, in good standing.
• Behavioral Health Master’s degree from an accredited program.
• Minimum 2 years in behavioral health with utilization reviews or case management.
• Ability to handle HIPAA confidential information with discretion.
• Strong interfacing skills with multiple providers across settings.
• Knowledge of medical, psychiatric, and psychological terminology and treatment planning.

Responsibilities

• Review medical records against criteria in contract requirements.
• Complete prior authorizations and retrospective reviews for behavioral health services.
• Collaborate with Clinical Director and Team Supervisor on provider trends and policy improvements.
• Determine medical necessity of services in collaboration with Medical Director.
• Serve as a resource for behavioral health providers and educate on reconsideration/appeal processes.
• Maintain client privacy, confidentiality, and compliance with regulatory standards.
• Read, understand, and adhere to corporate policies including HIPAA privacy and security rules.

Skills

HIPAA compliance

Provider engagement

Strong communication

Behavioral health knowledge

Clinical review

Education

Behavioral health master’s degree

Tools

Microsoft Office

Job description

Acentra Health, a national leader in health solutions, is seeking a Clinical Reviewer to apply clinical expertise to review medical records against contract criteria. This fully remote role requires Arkansas residency and focuses on prior authorization, continued stays, and quality reviews for behavioral health providers.

Collaborate with leadership to monitor provider trends, ensure medical necessity, and educate providers on reconsideration and appeal processes while upholding privacy, ethics,