Substance Use Utilization Management Reviewer (Remote)

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 – Substance Use (ASAM) Focus (Remote)

• Are you an experienced Clinical Reviewer looking for a new challenge?
• Do you value care management and quality improvement?
• Are you motivated, energetic, and excited to become part of the Acentra team?

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

This is a 20 hour/week position.

Who we need:

The Clinical Reviewer utilizes clinical expertise for the review of substance use and mental health medical records against the American Society of Addiction Medicine (ASAM) criteria in conjunction with contract requirements, critical thinking and decision making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with URAC and other regulatory standards.

What you’ll do:

• Review and interpret patient records to determine medical necessity and appropriateness of care; determines if the medical record documentation supports the need for services.
• Determine approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
• Abstract review related data/information accurately and timely on appropriate review tool by the appropriate means. Accurate and timely submission of all administrative and review related documents to appropriate parties.

• Perform ongoing reassessment of review process to offer opportunities for improvement and/or change.

• Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.

• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.

• Maintain medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.

• Utilize proper telephone etiquette and judicious use of other verbal and written communications, following KEPRO policies, procedures and guidelines

• Actively cross-train to perform duties of other contracts within the KEPRO network to provide a flexible workforce to meet client/consumer needs.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Knowledge, Skills, Abilities

• Knowledge of ASAM criteria strongly preferred.
• Knowledge of current URAC standards strongly preferred.
• Medical record abstracting skills required.
• Knowledge of the organization of medical records, medical terminology, and disease process required.
• Strong clinical assessment and critical thinking skills required.
• Excellent verbal and written communication skills required.
• Ability to work in a team environment.
• Flexibility and strong organizational skills needed.
• Must be proficient in Microsoft Office and internet/web navigation.

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

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.

Requirements

• Knowledge of ASAM criteria strongly preferred.
• Knowledge of current URAC standards strongly preferred.
• Medical record abstractin