Clinical Reviewer-Immediate Advocacy/Quality of Care (RN), 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/Quality of Care (RN) to join our growing team.

Job Summary:

The Clinical Reviewer is responsible for reviewing medical records to assess medical appropriateness based on established criteria and contract requirements. This role ensures the accuracy and timeliness of case reviews, collaborates on quality monitoring activities, and serves as a liaison for healthcare providers to resolve service-related issues. Located within the Care Management & Quality Oversight department, this position plays a critical part in supporting Acentra Health's mission to improve health outcomes through technology and clinical expertise.

Job Responsibilities:

• Ensure the accuracy and timely completion of case reviews in line with contract requirements
• Assess daily workloads and adjust schedules as needed to meet departmental demands
• Collaborate with the Supervisor on quality monitoring, identifying areas for improvement, and implementing enhancements
• Maintain current knowledge of review processes and clinical practices to provide guidance to nurse reviewers
• Act as a liaison for healthcare providers, addressing customer service issues and facilitating effective communication
• Conduct various review types based on workload requirements
• Foster positive and professional relationships with internal and external stakeholders to support the review process
• Attend training and meetings to stay updated on review protocols
• Cross-train on other contracts to support workforce flexibility and meet client needs

Required Qualifications/Experience:

• Active, unrestricted RN license, Social Worker license, or other clinical license valid in applicable state or compact state
• Bachelor's degree in a related field from an accredited institution
• Proficiency in medical terminology, record organization, and understanding of disease processes
• Strong clinical assessment and critical thinking skills
• Medical record abstracting skills
• Excellent written and verbal communication skills

Preferred Qualifications/Experience:

• Experience in a quality review role or with contract compliance
• Prior experience in a supervisory or quality oversight capacity
• Familiarity with electronic health record (EHR) systems

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 $25.07 to $34.62 per hour

"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.