Clinical Reviewer - Licensed Behavioral Health (Substance Abuse) - Full-time (Remote U.S.)

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 Clinical Reviewer - Behavioral Health (Substance Abuse) Full-time (Remote U.S.) 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 contractual requirements, critical thinking, and decision-making skills to determine medical appropriateness.

Responsibilities:

• Review and interpret patient records against American Society of Addiction Medicine (ASAM) criteria to determine medical necessity and appropriateness of care.
• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
• 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 the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Maintains current knowledge base related to review processes and clinical practices related to the review processes.
• Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.
• Fosters 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.
• Attends training and scheduled meetings and for maintenance and use of current/updated information for review.
• 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.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

** This is a full-time role working Monday through Friday from 8:00 AM until 5:00 PM in the time zone where the selected candidate resides. **

Required Qualifications/Experience:

• The selected candidate must hold an active, unrestricted Licensed Alcohol and Drug Counselor (LADC) issued by the Minnesota Board of Behavioral Health and Therapy (BBHT).
  
  
  • Note: If the selected candidate does not currently hold an active, unrestricted LADC in Minnesota, they must be eligible for and able to obtain the required licensure within six months of an accepting an offer.
    
    
• 3+ years of experience providing direct clinical work as a mental health professional across diverse clinical settings.
• 1+ years of Utilization Review (UR) OR Utilization Management (UM) OR Prior Authorization.
• In-depth understanding of ASAM criteria and its practical application in clinical environments.
• Familiarity with medical records structure, terminology, and disease processes.
• Strong clinical assessment capabilities paired with excellent critical thinking.
• Proficient in medical record abstraction.
• Excellent written and verbal communication skills.
• Demonstrated ability to manage deadlines, prioritize tasks, and thrive in a fast-paced environment.
• Highly organized with meticulous attention to detail.

Preferred Qualifications/Experience:

• Proficiency in Microsoft Office 365 applications, including Word, Excel, Outlook and Teams.

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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.

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.

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.”