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

CNSI and Kepro are now Acentra Health! 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 company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers 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 seeks a Clinical Reviewer – Behavioral Health – PRN (LCSW, LMSW, LAMFT, LMFT, LPE, LPE-I, LAC, LPC) (Remote in Arkansas) to join our growing team.

** 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.

Requirements

Required Qualifications / Experience

• Arkansas licensure in Social Work or counseling.

• A 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, 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.

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 healthcar