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 - Behavioral Health (within California) to join our growing team. Job Summary: As a Clinical Reviewer, you will conduct Utilization Reviews to assess the appropriateness, efficiency, and medical necessity of services. Utilizing your expertise, you will evaluate medical records against established criteria, applying critical thinking and sound judgment to determine the necessity of psychiatric inpatient care. With a strong emphasis on productivity and quality assurance, this role is instrumental in maintaining the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process, in accordance with the standards of the California Mental Health Services Authority (CalMHSA). This full-time, remote Clinical Reviewer position, based in California, ensures compliance with regulatory entities such as NCQA, URAC, and other governing bodies. It offers an opportunity to make a significant impact through clinical expertise-without direct patient interaction or communication. Responsibilities: Evaluate patient records to determine medical necessity and care appropriateness, ensuring documentation complies with established service requirements. Determine approval or initiate referrals to the physician consultant, process decisions, and provide detailed denials as needed. Accurately and timely abstract review-related data onto appropriate review tools and submit all administrative documents to relevant parties. Continuously reassess review processes for improvement opportunities and facilitate changes as necessary. Foster positive relationships, acting as a liaison with internal/external stakeholders to facilitate the review process and maintain professionalism. Attend training and meetings and maintain updated information for review purposes. Ensure medical record confidentiality by adhering to HIPAA policies and maintaining proper computer security measures. Utilize proper communication etiquette and adhere to Acentra Health policies in both verbal and written interactions. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

• * Residency and work location must be within the state of California. **
• * A valid California license as an LPCC, LCPC, LCMHC or LMHC, LMFT or LCSW. **
• * Availability required for an eight-hour shift scheduled between 8:00 AM and 6:00 PM Pacific Time. **

Qualifications Required Qualifications/Experience: Active, unrestricted California license in one of the following: LPCC (Licensed Professional Clinical Counselor) LCPC (Licensed Clinical Professional Counselor), LCMHC (Licensed Clinical Mental Health Counselor), LMHC (Licensed Mental Health Counselor), LMFT (Licensed Marriage and Family Therapist), and LCSW (Licensed Clinical Social Worker) issued by The California Board of Behavioral Sciences (BBS) . Master's degree from an accredited program in Social Work, Counseling, Psychology, or a related behavioral health field. 1+ years of experience working with Medicaid, government-funded health plans, or hospital-based programs. 1+ years evaluating patient records to determine medical necessity and care appropriateness, ensuring documentation complies with established service requirements. In-depth knowledge of the Mental Health Parity and Addiction Equity Act and the Substance Use Disorder Services Final Rule. Strong understanding of psychiatric disorders and clinical standards related to Level of Care determinations and mental health assessments. Proven ability to develop accurate level-of-care recommendations based on clinical documentation and medical record evaluations. Clinical expertise in diagnosing psychological and behavioral conditions, with the ability to consider complex co-occurring factors. Skilled in conducting comprehensive assessments across psychological, emotional, behavioral, and physical health domains. Highly detail-oriented with strong time management, task prioritization, and execution abilities in a fast-paced environment. Proficient in Microsoft Office Suite, including Excel, Word, PowerPoint, Teams, and Outlook. Preferred Qualifications/Experience: Familiarity with public-sector healthcare systems and community-based support services. Strong working knowledge of Medicaid programs, including experience managing or supporting related healthcare initiatives.

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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. 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." 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 Health 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. Pay Range USD $22.69 - USD $41.00 /Hr. Acentra Health

Job Tags

Full time, Local area, Shift work,

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