Clinical Reviewer-Immediate Advocacy (RN/LCSW)-Remote

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 is looking for a Clinical Reviewer-Immediate Advocacy (RN/LCSW)-Remote to join our growing team.

Job Summary:

The Clinical Reviewer is responsible for assessing medical records against established criteria and contract requirements to determine medical appropriateness. The role plays a critical part in ensuring accurate and timely reviews while collaborating with internal and external stakeholders to maintain compliance and improve outcomes

Job Responsibilities:

• Ensure the accuracy and timeliness of reviews across all applicable case types per contract standards
• Assess and manage daily workloads, adjusting schedules to meet departmental demands
• Conduct quality monitoring activities, identifying areas for improvement and implementing necessary changes
• Stay current with review processes and clinical practices, acting as the primary resource for nurse reviewers
• Serve as the provider liaison for customer service inquiries and resolution of issues
• Perform diverse review types to meet workload demands
• Build positive relationships with internal and external customers to streamline the review process
• Attend trainings and meetings to remain updated on review protocols and procedures
• Support cross-training initiatives to provide flexibility and meet client and customer needs

Required Qualifications/Experience:

• Active unrestricted RN clinical license (or equivalent clinical license)

• Minimum two years of clinical experience in an acute, med-surgical, post-acute, psychiatric, or rehabilitation environment
• Minimum of one year Case management, Care Coordination, Discharge Planning or related experience
• Must be proficient in computer skills including Microsoft Office and internet/web navigation

• Knowledge of medical record organization, terminology, and disease processes

• Strong clinical assessment and critical thinking skills
• Excellent written and verbal communication skills

• Experience in utilization review or prior authorization processes
• Demonstrated ability to manage complex cases with a focus on accuracy and efficiency
• Familiarity with healthcare technologies and quality improvement initiatives

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.

Compensation

The pay range for this position is $22.56 - $33.00

"Based on our compensation program, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

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

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