Clinical Reviewer

4 weeks ago


Little Rock, Arkansas, United States CNSI Full time
Job Summary:

CNSI is seeking a skilled Clinical Reviewer to join our team. As a Clinical Reviewer, you will be responsible for completing prior authorization, continued stay, and retroactive and retrospective quality reviews for Inpatient and Outpatient Behavioral Health Providers.

Key Responsibilities:

Completes initial and concurrent prior authorization and retrospective reviews for Behavioral Health services.
Performs reviews assessing the quality and compliance of services documentation in the client record, ensuring documentation complies with relevant Arkansas Medicaid regulations and referring services to the Physician Reviewer for medical necessity determination if warranted.
Acts as a liaison for Behavioral Health Providers regarding the review process.
Educates Behavioral Health Providers on the Reconsideration and Appeal process.

Requirements:

Arkansas licensure in Social Work or Counseling issued by the Arkansas Board of Examiners in Counseling and Marriage & Family Therapy.
Master's degree-level Behavioral Health professional licensed in the State of Arkansas (e.g., LCSW, LMSW, LAMFT, LMFT, LPE, LPE-I, LAC, LPC) in good standing with a specialty in child and adolescent behavior.
2+ years of experience in a behavioral health setting, conducting behavioral health utilization reviews or behavioral health case management.
Ability to work with HIPAA confidential information.
Ability to interface with multiple providers.
Knowledge of medical/psychiatric and psychological terminology, mental health assessment tools, treatment plans, delivery of behavioral health services, and an understanding of acute inpatient, residential care, and outpatient home and community behavioral health services.
Knowledge of and experience with government-funded behavioral health programs as well as policies and procedures of government-funded behavioral health programs.
Knowledge and experience with automated review systems and Microsoft Office Suite.
Excellent interpersonal skills in establishing and maintaining good rapport with physicians, behavioral health providers, and family members.
Must possess a sense of responsibility and accountability, self-motivation, and detail-oriented with excellent listening, verbal, and written communication skills.
Strong clinical skills to apply to the assessment of services based on review of clinical records.

Preferred Qualifications:

Utilization Review/Utilization Management experience.
Clinical quality review experience with medical records.
Medical necessity review criteria for Arkansas Medicaid.
Familiarity with Arkansas Medicaid behavioral health policies.

About CNSI:

CNSI is a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. We are a vital partner to state and federal healthcare agencies, providers, and employers, ensuring better healthcare and improving health outcomes. Our people are our greatest asset, and we offer a comprehensive benefits package, including comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.
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