Virginia Licensed Lead Clinical Reviewer

Acentra Health; United States; Remote; USD 70,000 - 90,000; Full time

Job summary

A healthcare company is seeking a Lead Clinical Reviewer to evaluate medical records for appropriateness. The role requires a Master's degree, a Virginia license as a Mental Health Professional, and over 2 years of relevant experience. Responsibilities include guiding team members and conducting quality audits to improve processes.

Qualifications

• Active and unrestricted license as a Mental Health Professional in Virginia.
• 2+ years of experience in Prior Authorization, Utilization Review, or Utilization Management.

Responsibilities

• Review medical records against criteria to determine medical appropriateness.
• Support training and documentation efforts.
• Identify areas for improvement through quality monitoring and audits.

Skills

Review medical records

Guide team members

Conduct quality monitoring

Education

Master's degree from an accredited college

Job description

A company is looking for a Lead Clinical Reviewer to join their team.

Key Responsibilities

• Review medical records against criteria to determine medical appropriateness
• Guide team members and support training and documentation efforts
• Conduct quality monitoring and audits, identifying areas for improvement

Required Qualifications

• Active and unrestricted license as a Mental Health Professional in Virginia
• Master's degree from an accredited college in a relevant program
• 2+ years of experience in Prior Authorization, Utilization Review, or Utilization Management