Utilization Clinical Reviewer - (LCSW/LMFT/LPCC/LCPC) - Remote Must Reside in CA - Los Angeles, California, United States - Remote

CNSI and Kepro are now Acentra Health! 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 company’s mission, actively engage in problem-solving, and take ownership of your work daily. 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 seeks aUtilization Clinical Reviewer - LCSW/LMFT/LPCC/LCPC (Remote within California) to join our growing team.

Job Summary

Utilizing clinical expertise, this role involves reviewing medical records against appropriate criteria and employing critical thinking and decision-making skills to assess the medical appropriateness of psychiatric inpatient care. Maintaining production goals and QA standards, this position ensures the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA). Compliance with NCQA, URAC, and other regulatory standards is a key aspect. This remote position does not require any interaction or communication with patients and is non-patient-facing.

** A California LCSW/LMFT/LPCC/LCPC License is Required. **

** The selected candidate must reside and work in California. **

Job Responsibilities

• Review and interpret patient records against established criteria to determine medical necessity and care appropriateness, ensuring documentation supports service requirements.
• Determine approval or initiate referrals to the physician consultant, processing decisions and providing detailed denials as needed.
• Accurately and timely abstract review-related data …