Job Summary
As a Clinical Reviewer, you will use your clinical background to review medical records and support accurate, timely determinations, helping ensure consistency with established guidelines and program requirements. This role may also support comprehensive behavioral health assessments for children and adolescents, contributing to level-of-care determinations and service eligibility decisions within statewide healthcare programs.
This full-time, remote position requires a Maine license and offers the opportunity to apply your clinical expertise in support of statewide healthcare programs.
Job Responsibilities
- Conduct or support behavioral health assessments for pediatric populations, including evaluating functional needs, risk factors, and clinical history.
- Contribute to level-of-care determinations and eligibility decisions for moderate to high-intensity behavioral health services.
- Review and synthesize clinical, behavioral, and psychosocial information to support comprehensive assessment outcomes and care planning.
- Review assigned cases for accuracy, completeness, and timeliness in alignment with program requirements and regulatory standards.
- Manage daily caseload and prioritize work to meet established turnaround times.
- Apply clinical guidelines and criteria to support consistent, well-documented determinations.
- Participate in quality assurance and continuous improvement efforts.
- Stay current on clinical standards, regulatory updates, and review criteria.
- Communicate with providers as needed to clarify information and support issue resolution.
- Handle a variety of review types based on business needs.
- Collaborate with internal teams to ensure efficient workflow and consistent outcomes.
- Participate in training, team meetings, and ongoing professional development.
- Follow all company policies, including strict adherence to HIPAA privacy and security requirements.
Required Qualifications
- Active, unrestricted LCPC or LCSW license.
- Must hold an active license in the State of Maine.
- Experience with medical record review and clinical documentation.
- Working knowledge of medical terminology.
- Strong written and verbal communication skills.
Preferred Qualifications
- Experience supporting public sector or government healthcare programs.
- Strong organizational skills with the ability to manage multiple priorities.
- Comfortable working in a remote, production-driven environment.
- Proficiency with Microsoft Office (Word, Excel, Outlook) and web-based systems.
Attention Applicants: Please be advised that proper email communication will only be sent from email addresses ending in @astyra.com. Please ensure you are communicating with approved Astyra recruiters by checking this point when receiving offers and messages from us. It is important to communicate within our guidelines and proper channels to expedite possible interview considerations.
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