Clinical Behavioral Health Reviewer Psychologist-PRN (Hybrid in South Carolina)

Company Description

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.

Job Description

Clinical Behavioral Health Reviewer Psychologist - Hybrid (Remote within South Carolina)

• Are you an experienced Clinical Behavioral Health Reviewer Psychologist 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!

** For this opportunity, the selected candidate must reside in South Carolina. **
** Site visits are to be conducted during regular work hours, 8:00 AM-5:00 PM, Monday through Friday, and Peer Reviews are to be conducted within one day of receipt during regular work hours, after hours, or on weekends. **

Who we need:

The Clinical Behavioral Health Reviewer Psychologist - PRN will provide leadership and expertise to operations related to the peer review process, utilization review activities, and other activities requiring clinical leadership and consultation.

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:

• Conduct monthly ICF/MR level of care reviews as required by CMS Quality Framework.
• Conduct second-level reviews for behavioral health services to include, but are not limited to, IP psych, PRTF, Assertive Community Treatment, and Autism Spectrum Disorder.
• Conduct onsite visits for free-standing Inpatient Psychiatric hospitals and PRTF according to the contractual schedule.
• Conduct peer-to-peer physician consultations as requested/required and document accordingly.
• Provide clinical expertise with respect to planning and establishing goals and policies to improve behavioral health clinical operations.
• Review behavioral health information trends, experiences, and approaches and assist in the development of strategic plans for clinical improvements.
• Analyze and remain current on national, state, and local regulations and legislation that impacts the behavioral health profession.
• Represent and promote Acentra Health, as appropriate.

Qualifications

What you’ll need:

Required Qualifications / Experience

• Master’s degree in psychology and have 4+ years of clinical experience related to Mental Retardation and Related Disabilities (MR/RD).
  
  OR
  
  Licensed as a Psychologist in South Carolina and have 2+ years of clinical experience in Mental Retardation and Related Disabilities (MR/RD).
   
• Experience in Utilization Management (UM) with knowledge of Medicaid and Medicare programs.
• Experience in Utilization Review (UR) and peer-to-peer reviews.

Required Knowledge, Skills, Abilities

• Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual (DSM-5) in use in South Carolina.
• Computer proficient in Microsoft Excel, Word, PowerPoint, Teams, and Outlook.
• Ability to determine a clinical diagnosis and account for psychological and behavioral issues.
• Ability to interact with healthcare professionals, patients, families, and other support.
• Ability to a