Clinical Reviewer

Company Overview

Acentra Health focuses on improving health outcomes by combining technology, services, and clinical expertise. The organization’s mission is to create health solutions that deliver strong value and measurable impact. Its guiding philosophy, “Lead the Way,” encourages employees to take initiative, solve problems proactively, and own their work every day.

The company describes this role as an opportunity to contribute to public-sector health solutions while growing within a team of dedicated professionals.

Job Summary

The Clinical Reviewer will examine medical records using the correct criteria and contract guidelines to decide whether care is medically appropriate. This is a remote role.

The standard schedule is Monday through Friday, 8:00 AM to 5:00 PM Eastern, with one additional day every other week from 10:00 AM to 7:00 PM Eastern as assigned.

Responsibilities

• Complete review cases accurately and on time in line with contract rules and deadlines.
• Monitor daily caseloads and queues, then adapt the work schedule as needed to keep up with department demand.
• Work with a supervisor on quality monitoring, including spotting improvement opportunities and carrying out corrective actions.
• Keep up to date on review procedures and clinical practices, and serve as an internal reference for nurse reviewers with questions or concerns.
• Act as a liaison for providers and support customer service and issue resolution.
• Carry out all applicable review types based on workload needs.
• Build and maintain professional relationships with internal and external stakeholders to support effective teamwork and a smooth review process.
• Attend training sessions and scheduled meetings to stay current on updated review information.
• Cross-train on other contracts and help wherever needed to support workforce flexibility and customer needs.
• Follow all company policies, including HIPAA Privacy and Security Rules.
• Take on additional duties as assigned by management when needed.

Requirements

• Active, unrestricted LPN, LVN, or RN license in the state where you live, subject to contract and state requirements.
• Associate degree, practical/vocational nursing diploma, or nursing certificate program in line with state requirements.
• Ability to abstract and interpret medical records, including understanding record structure, medical terminology, and disease processes.
• Strong clinical judgment and critical-thinking ability.
• Availability to work the stated Eastern Time schedule, including the every-other-week extended day.
• Preferred: bachelor’s degree from an accredited college or university in a related field.
• Preferred: 1+ year of utilization management or utilization review experience.
• Preferred: 1+ year of private duty nursing or home health experience.
• Preferred: strong written and verbal communication skills.

Benefits

The benefits package includes comprehensive health coverage, paid time off, retirement savings, corporate wellness support, educational assistance, corporate discounts, and additional employee support offerings.

Additional Information

The company states that it values employees and aims to provide meaningful work that improves lives across the country. It also notes that practical experience may sometimes be accepted in place of a degree: for non-clinical roles, or when the contract does not specifically require a degree, six years of directly relevant experience may substitute for a bachelor’s degree, and three years of directly relevant experience may substitute for a bachelor’s degree when the candidate already has an associate degree.

Employment consideration is based on the applicant’s experience and skill level within the pay range.

The employer follows equal opportunity hiring practices and considers all qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, disability, veteran status, or other protected status under applicable law.

The posting also states that due to application volume, only candidates selected to move forward in the hiring process will be contacted.

Listed pay range: $28.37 to $35.00 per hour.