Clinical Reviewer (BHJOB1435_35266)

Delivering smart solutions with an eye on People, Process, and Technology Our team is comprised of individuals rich with recruiting experience, technology knowledge, and customer service. Dedicated to their community, clients and associates, these individuals have a common mantra: “We will make it happen, deliver on our promises and manage every detail along the way.” Our internal slogan of P.R.I.D.E. (Putting Remarkable Into Daily Efforts) is our driving focus. Our skilled associates, led by this team of professionals, enable organizations to achieve their business and personnel needs both quickly and cost effectively.

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.

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.