Utilization Clinical Reviewer (Remote within California)

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 a Utilization Clinical Reviewer to join our growing 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 in alignment with the esteemed California Mental Health Services Authority (CalMHSA). Adhering rigorously to standards set by NCQA, URAC, and other regulatory bodies, you'll play a pivotal role in upholding industry benchmarks. This full-time Utilization Clinical Reviewer remote position based in California provides an opportunity for impactful work without requiring direct patient interaction or communication.

** 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 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 verbal and written interactions.
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