Remote Behavioral Health Clinical Reviewer

Acentra Health; Little Rock (AR); Remote; USD 39,000 - 54,000; Full time

Benefits offered by this job

Comprehensive health plans

Paid time off

Retirement savings

Corporate wellness

Educational assistance

Corporate discounts

And more

Job summary

Acentra Health is seeking a Clinical Reviewer to join our remotely-based team. You will use clinical expertise to review medical records, complete prior authorizations, and perform quality reviews for inpatient and outpatient behavioral health services in alignment with contract requirements.

You will collaborate with leadership to monitor provider trends, ensure medical necessity, and educate Behavioral Health Providers on reconsideration and appeal processes, while safeguarding privacy and

Qualifications

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

Responsibilities

• Review medical records against criteria and contract requirements.
• Complete prior authorization, continued stay and retrospective reviews for behavioral health providers.
• Collaborate with Clinical Director and Team Supervisor on provider trends and policy improvements.
• Determine medical necessity in coordination with the Medical Director.
• Serve as a resource for behavioral health providers and educate on reconsideration/appeal processes.
• Maintain client privacy, confidentiality, and adherence to regulatory standards.
• Attend trainings, meet deadlines, and cross-train for flexible staffing.
• Read and adhere to HIPAA, privacy, and security policies.

Skills

Interfacing with providers

Medical terminology

Regulatory compliance

HIPAA knowledge

Interpersonal skills

Education

Behavioral Health Master's degree

Job description

Acentra Health is seeking a Clinical Reviewer to join our remotely-based team. You will use clinical expertise to review medical records, complete prior authorizations, and perform quality reviews for inpatient and outpatient behavioral health services in alignment with contract requirements.

You will collaborate with leadership to monitor provider trends, ensure medical necessity, and educate Behavioral Health Providers on reconsideration and appeal processes, while safeguarding privacy and