Clinical Reviewer - Behavioral Health Full-Time (Remote in Arkansas)

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Clinical Reviewer – Behavioral Health (LCSW, LMSW, LAMFT, LMFT, LPE, LPE-I, LAC, LPC) (Remote in Arkansas)

• Are you an experienced Clinical Reviewer – Behavioral Health looking for a new challenge?
• Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?

If so, you might be our next new team member!

** The work hours for this role are 8:00 AM – 5:00 PM Central, Monday through Friday. **

** 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. **

Who we need:

Clinical Reviewer – Behavioral Health who:

• Completes prior authorization, continued stay, retroactive and retrospective quality reviews for Inpatient and Outpatient Behavior 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 at all times.
• Adherence to ethical, legal, and accreditation/regulatory standards.

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.

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

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.

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

What you’ll do:

• Complete initial and concurrent prior authorization and retrospective reviews for Behavioral Health services.
• Perform reviews assessing the quality and compliance of documentation of services 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.
• Act as a liaison for Behavioral Health Providers regarding the review process.
• Educate Behavioral Health Providers on the Reconsideration and Appeal process.

What you’ll need:

Required Qualifications / Experience

• Arkansas licensure in Social Work or counseling.
• Master’s degree level Behavioral Health professional licensed in the State of Arkansas (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, behavioral health utilization review, 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.

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