Clinical Reviewer - Arkansas Behavioral Health License - PRN (Remote reputed company Arkansas)

Company Overview: reputed company exists to reputed company reputed company outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. reputed company the Way is our rallying cry at reputed company. 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. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company outcomes – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities: reputed company is looking for a Clinical Reviewer - Arkansas Behavioral Health License - PRN (Remote reputed company Arkansas) 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 contract requirements.
• Completes prior authorization, reputed company stay, and retroactive and retrospective quality reviews for Inpatient and Outpatient Behavioral Health Providers.
• Collaborates with the Clinical Director and Team Supervisor to:
• Monitor provider trends
• Review government-funded behavioral health program utilization activities
• Recommend internal policies, procedures, and processes
• Collaborates with Team Supervisor and Medical Director to determine Medical Necessity of services.
• Serves as a resource for Behavioral Health providers.
• Assists Provider Relations Specialist with program-specific education and training.
• Maintains client privacy, confidentiality, and safety at reputed company times.
• Ensures adherence to ethical, legal, and accreditation/regulatory standards.

Responsibilities:

• Assures accuracy and timeliness of reputed company applicable review type cases reputed company 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 quality monitoring activities.
• Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices.
• Performs reputed company applicable review types as workload indicates.
• Fosters positive and professional relationships with internal and external customers.
• Attends training and scheduled meetings for reputed company/updated information.
• Cross trains to provide flexible workforce to meet client/customer needs.
• Conducts initial and reputed company prior authorization and retrospective reviews for Behavioral Health services.
• Evaluates the quality and compliance of service documentation in client records, ensuring adherence to Arkansas Medicaid regulations.
• Refers cases to the Physician Reviewer for medical necessity determinations reputed company appropriate.
• Serves as a liaison between the organization and Behavioral Health Providers throughout the review process.
• Provides education to Behavioral Health Providers on the Reconsideration and Appeal process.
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company Rules.
• * This is a fully remote position where you must reside and work in the state of Arkansas. **

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• The scheduled Work Hours for this PRN role would be weekdays between the hours of 8:00 AM to 5:00 PM Central. The schedule would be discussed during the interview process. **

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• There is no required Travel for this role. **

Qualifications: Required Qualifications/Experience:

• Hold an active, unrestricted Arkansas licensure in Social Work OR Counseling OR Psychology issued by the Arkansas Social Work Licensing Board OR Arkansas Board of Examiners in Counseling and Marriage & Family Therapy OR Arkansas Psychology Board in good standing, in one of the following:
• LCSW, LMSW
• LAMFT, LMFT
• LAC, LPC
• LPE, LPE-I
• A Behavioral Health Master's degree from an accredited college or university in a reputed company field.
• 2+ years of experience in a behavioral health setting, conducting utilization reviews or behavioral health case management.
• Ability to handle HIPAA confidential information with discretion.
• Skilled in interfacing with multiple providers across various settings.
• Strong knowledge of:
• Medical, psychiatric, and psychological terminology
• Mental health assessment tools and treatment plans
• Delivery of behavioral health services across acute inpatient, and outpatient home and community settings
• Familiarity with government-funded behavioral health programs, including their policies and procedures.
• Excellent interpersonal skills for building rapport with physicians, behavioral health providers, and family members.
• Highly responsible, self-motivated, and detail-oriented with strong listening, verbal, and written communication skills.
• Solid clinical skills for assessing services based on clinical record reviews.
• Excellent written and verbal communication skills.

Preferred Qualifications/Experience:

• Experience with Child and Adolescent Behavior.
• Experience in Utilization Review (UR) and Utilization Management (UM) reputed company behavioral health or medical settings.
• Clinical quality review experience, including the evaluation of medical records.
• Familiarity with medical necessity review criteria specific to Arkansas Medicaid.
• In-depth knowledge of Arkansas Medicaid behavioral health policies and procedures.
• Proficient in automated review systems and reputed company Office Suite.

#LI-SD1 Why us? We are a team of reputed company 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 reputed company 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 reputed company 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 reputed company and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The reputed company reputed company Team Visit us at reputed company EEO AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national reputed company, 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 reputed company level.” Pay Range: USD $28.37 - USD $39.19 /Hr. Remote About the Company: reputed company Apply tot his job Apply To this Job