Clinical Reviewer - Behavioral Health - PRN (Remote within Arkansas)

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.

Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN (Remote within Arkansas)

** The selected candidate must be available for at least the first 90 days between 8:00 AM - 5:00 PM Central, Monday through Friday, but the availability can vary. **

** This is a fully remote position where you must reside and work in the state of Arkansas. **

** There is no required Travel for this role. **

Job Summary:

• Completes prior authorization, continued stay, and retroactive and retrospective quality reviews for Inpatient and Outpatient Behavioral Health Providers.
• Collaborates with the Clinical Director and Team Supervisor, monitors provider trends, reviews government-funded behavioral health program utilization activities, and makes internal policy, procedure, and process recommendations.
• Collaborates with Team Supervisor and Medical Director to determine Medical Necessity of services.
• Serves as a resource for Behavioral Health providers.
• Assists Provider Relations Specialist with program-specific education and training.
• Maintains client's privacy, confidentiality, and safety always.
• Adherence to ethical, legal, and accreditation/regulatory standards.

Job Responsibilities:

• Completes initial and concurrent prior authorization and retrospective reviews for Behavioral Health services.
• Performs reviews assessing the quality and compliance of services documentation in the client record, ensuring documentation complies with relevant Arkansas Medicaid regulations and referring services to the Physician Reviewer for medical necessity determination if warranted.
• Acts as a liaison for Behavioral Health Providers regarding the review process.
• Educates Behavioral Health Providers on the Reconsideration and Appeal process.

Required Qualifications/Experience:

• Arkansas licensure in Social Work OR Counseling issued by the Arkansas Board of Examiners in Counseling and Marriage & Family Therapy.

• Master's degree-level Behavioral Health professional licensed in the State of Arkansas (e.g., LCSW, LMSW, LAMFT, LMFT, LPE, LPE-I, LAC, LPC) in good standing with a specialty in child and adolescent behavior.
• 2+ years of experience in a behavioral health setting, conducting behavioral health utilization reviews or behavioral health case management.
• Ability to work with HIPAA confidential information.
• Ability to interface with multiple providers.
• Knowledge of medical/psychiatric and psychological terminology, mental health assessment tools, treatment plans, delivery of behavioral health services, and an understanding of acute inpatient, residential care, and outpatient home and community behavioral health services.
• Knowledge of and experience with government-funded behavioral health programs as well as policies and procedures of government-funded behavioral health programs.
• Knowledge and experience with automated review systems and Microsoft Office Suite.
• Excellent interpersonal skills in establishing and maintaining good rapport with physicians, behavioral health providers, and family members.
• Must possess a sense of responsibility and accountability, self-motivation, and detail-oriented with excellent listening, verbal, and written communication skills.
• Strong clinical skills to apply to the assessment of services based on review of clinical records.

Preferred Qualifications/Experience:

• Utilization Review/Utilization Management experience.
• Clinical quality review experience with medical records.
• Medical necessity review criteria for Arkansas Medicaid.
• Familiarity with Arkansas Medicaid behavioral health policies.

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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.

Compensation

The pay range for this position is $22.56-35.82 per hour.

"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

Visit us at Acentra.com/careers/

EOE 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.