Report this job

---

What is the problem? *

Incorrect company
Incorrect location
Job is expired
Job may be a scam
Other

Utilization Clinical Reviewer (Remote-In California) (LMFT, LCSW, LPCC, LCPC Only) ($38.50-$40.87/Hour)

• Are you an experienced LMFT, LCSW, LPCC, or LCPC looking for a new challenge?
• Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?

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

Salary: $80,000 - $85,000

Who we need:

The Clinical Reviewer utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness of psychiatric inpatient level of care while maintaining production goals and QA standards. Supports overall consistency, thoroughness, and accuracy of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA). Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards.

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.

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

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 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.

What youll do:

• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; determine if the medical record documentation supports the need for services.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring the reason for the denial is described in sufficient detail on correspondence.
• Abstracts 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.
• Performs ongoing reassessment of the 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 in order to facilitate the review process.
• Responsible for attending training and scheduled meetings and maintenance and use of current/updated information for review.
• Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
• Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures, and guidelines
• Actively cross-trains to perform duties of other contracts within the Acentra Health 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.

What youll need:

Required Qualifications

• Active California License (i.e., LPCC, LCPC, LMFT, LCSW).
• Graduation from an accredited Master's Degree Program.

Knowledge, Skills, Abilities

• Knowledge of Parity in Mental Health and Substance Use Disorder Services Final Rule (Parity Rule; Title 42 of the CFR, part 438.910)
• Knowledge of Medicaid programs with relevant experience navigating similar complex projects.
• Knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual in use in California.
• Knowledge of standards of practice related to the determination of the Level of Care.
• Knowledge of standards of practice related to mental health and other disorders typically requiring psychiatric inpatient.
• Knowledge and understanding of public sector services and supports.
• Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, and Outlook.
• Ability to determine a clinical diagnosis accounting for psychological and behavioral issues.
• Ability to utilize computer equipment and web-based software to conduct work.
• Ability to interact with various office staff as needed to support necessary workflows.
• Ability to interact with healthcare professionals, patients, their families, and other supports.
• Ability to communicate effectively to individuals and groups through spoken, written, and electronic media.
• Ability to attend to detail, effectively prioritize, and execute tasks in a timely manner.
• Assesses and analyzes psychological, emotional, behavioral, and physical functioning.
• Develops level of care recommendations based upon clinical evaluations.

Experience

• Minimum experience of two (2) years managing and/or working with Medicaid, government health plans, or hospital programs.

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

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.