Utilization Clinical Reviewer (Remote within the State of Maine)

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.

Acentra Health is looking for a Utilization Clinical Reviewer to join our growing and dynamic team!

Job Summary

As a Utilization Clinical Reviewer, you'll harness your expertise to meticulously evaluate medical records against precise criteria, wielding critical thinking and decisive skills to appraise the medical necessity of psychiatric inpatient care. With a focus on meeting production targets and maintaining top-tier quality assurance standards, this role serves as the linchpin for ensuring the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process. This full-time Clinical Reviewer Remote position based in the state of Maine. This provides an opportunity for impactful work without requiring direct patient interaction or communication.

* A Maine LCSW or LCPC License is Required. The selected candidate must reside and work in Maine *

Job Responsibilities:

• Analyze and interpret patient records based on established criteria to determine medical necessity and care appropriateness, ensuring all documentation complies with service requirements.

• Approve services or refer cases to a physician consultant as needed, providing detailed explanations for denials and ensuring timely and accurate processing of decisions.

• Accurately abstract and record review-related data using the appropriate review tools, and submit all required administrative documents to relevant parties promptly.

• Continuously reassess review processes to identify opportunities for improvement, recommending and facilitating necessary changes to enhance efficiency.

• Build and maintain positive relationships with internal and external stakeholders, acting as a professional liaison to support the review process.

• Participate in training sessions and meetings, staying informed and up to date on review processes and requirements.

• Ensure strict adherence to HIPAA policies by maintaining medical record confidentiality and employing appropriate computer security measures.

• Exhibit proper communication etiquette in verbal and written interactions, ensuring alignment with Acentra Health's policies and professional standards

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

Required Qualifications, Skills and Experience:

• A minimum of 2 years of experience working with psychiatric disorders, including applying standards of practice to determine levels of care and conducting comprehensive mental health assessments

• An active Maine license is required in one of the following fields: Licensed Clinical Social Worker (LCSW) or Licensed Clinical Professional Counselor (LCPC).

• Must have graduated from an accredited Master's Degree program.

• Ability to make clinical diagnoses while accounting for psychological and behavioral factors.
• Recent or previous experience managing or working with Medicaid, government health plans, or hospital programs.
• Familarity and understanding of public sector services and supports.

• Proficient with computer equipment and web-based software to conduct work effectively.

• Highly detail-oriented with strong prioritization and task execution skills.

• Proficient in assessing and analyzing psychological, emotional, behavioral, and physical functions.

• Comprehensive understanding of Medicaid programs with proven experience navigating similar projects.

• Ability to develop accurate level-of-care recommendations based on clinical medical records and evaluations.

• Proficient in Microsoft Excel, Word, PowerPoint, Teams, and Outlook.

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 nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career.

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.

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.

Compensation

The compensation for this role is $32.00 to $35.00 per hour

Based on our compensation program, 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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