Behavioral Health Clinical Reviewer

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 Behavioral Health Clinical Reviewer to join our growing team.

Job Summary:

The purpose of this position is to conduct administrative and process-based reviews of medical records related to Applied Behavior Analysis (ABA) services. The BCBA Clinical Reviewer evaluates documentation against established criteria and contractual requirements to determine medical appropriateness. This role does not involve direct clinical judgment regarding patient care or therapeutic decisions. Instead, the focus is on ensuring compliance, accuracy, and completeness of ABA documentation in accordance with applicable guidelines.

Responsibilities:

• Conduct prospective, concurrent, and retrospective reviews of Behavioral Health services, with a focus on Applied Behavior Analysis (ABA).
• Evaluate age-appropriate testing, evaluation, and assessment tools to determine the appropriateness of ABA therapy.
• Ensure accuracy and timeliness of all review types in accordance with contract requirements.
• Monitor and manage daily workload and review queues, adjusting schedules as needed to meet departmental demands.
• Collaborate with the Supervisor on quality monitoring activities, identifying areas for improvement and supporting implementation efforts.
• Maintain current knowledge of review processes, clinical practices, and relevant guidelines.
• Serve as the first-line reviewer for ABA prior authorization requests, based on workload needs.
• Act as a liaison and resource for providers, addressing client/patient service issues and facilitating problem resolution.
• Foster positive, professional relationships with internal and external stakeholders to support effective review processes.
• Participate in training sessions and scheduled meetings to stay updated on review protocols and industry standards.
• Adhere to all corporate policies, including those related to HIPAA Privacy and Security Rules.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Required Qualifications

• Master's degree in psychology, Behavior Analysis, or another relevant field is required
• Requires 4 - 7 years of experience in Applied Behavior Analysis (ABA) or a related clinical field.
• Requires certification as a Board-Certified Behavior Analyst (BCBA)

Preferred Qualifications

• Require excellent written and verbal communication skills and the ability to collaborate with families and other medical professionals
• Utilization review and/or case management experience is preferred
• Medicaid/Medicare/Commercial experience is preferred
• Understanding of ABA principles, clinical practices, and therapeutic techniques
• Knowledge of the organization of medical records, medical terminology, and disease process required.
• Excellent organizational skills
• Strong clinical assessment and critical thinking skills required.
• Medical record abstracting skills required.

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.

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 https://careers.acentra.com/jobs

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, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

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."