Job Description

Company Overview 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. Job Summary and Responsibilities Acentra Health is looking for a Clinical Reviewer of behavioral health to join our growing team. Job Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements. Responsibilities: Assures accuracy and timeliness of all applicable review type cases within contract requirements Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department In collaboration with Supervisor, responsible for quality monitoring activities Maintains current knowledge base related to review processes and clinical practices Functions as providers' liaison for customer service issues and problem resolution Performs all applicable review types as workload indicates Fosters positive and professional relationships with internal and external customers Attends training and scheduled meetings for current/updated information Cross trains to provide flexible workforce to meet client/customer needs Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules Qualifications Required Qualifications Active unrestricted license for the State of Virginia or compact license in Licensed Practical Nurse (LPN), Registered Nurse (RN), or a Licensed Mental Health Professional (LMHP) - the same as defined in physician, licensed clinical psychologist (LCP), licensed professional counselor (LPC), licensed clinical social worker (LCSW), licensed substance abuse treatment practitioner (LSATP), licensed marriage and family therapist (LMFT), certified psychiatric clinical nurse specialist (CPCNS), licensed behavior analyst (LBA), or licensed psychiatric/mental health nurse practitioner Bachelor's Degree from an accredited college or university in a related field (masters preferred) 1+ years of experience in utilization management (UM) 1+ years of experience in behavioral health Preferred Qualifications Exposure to Virginia Medicaid Experience conducting clinical reviews for utilization management Competency in Microsoft Office (i.e. Teams, Outlook, Excel) Knowledge of medical records, medical terminology, and disease processes Strong clinical assessment and critical thinking skills Excellent written and verbal communication skills 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. Benefits 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. 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/ EEO 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. Compensation The pay range for this position is listed below. "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."

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