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 BFCC IA/QOC (LPN, RN, or SW) to join our growing team.
Job Summary:
The Clinical Reviewer utilizes clinical expertise to conduct beneficiary interactions and medical record reviews in alignment with contract requirements. Leveraging critical thinking and decision-making skills, the role ensures communication of medical appropriateness, supports care coordination, and maintains compliance with NCQA and regulatory standards. This position is key to ensuring high-quality healthcare delivery and achieving department goals.
Job Responsibilities:
- Ensure accuracy and timeliness of medical record reviews as per contract requirements
- Monitor and manage daily workload to meet departmental demands effectively
- Provide care coordination, case management, and discharge planning support to beneficiaries and their representatives
- Assist in quality monitoring activities, including identifying improvement areas and implementing action plans
- Serve as a resource for nurse reviewers and liaise with providers to resolve customer service issues
- Maintain a strong knowledge base of clinical practices and review processes
- Foster professional relationships with internal and external stakeholders to facilitate seamless operations
- Participate in training and meetings to stay updated on review protocols and industry standards
- Cross-train to support other contracts as needed to ensure workforce flexibility
Requirements
Required Qualifications/Experience:
- Active, unrestricted LPN, RN, or Social Worker license (State or Compact State, as per contract requirements)
- Minimum two years of clinical experience in an acute or med-surgical setting
- Familiarity with medical records organization, terminology, and disease processes
- Strong clinical assessment and critical thinking abilities
- Proficiency in Microsoft Office and internet navigation
- Excellent verbal and written communication skills
Preferred Qualifications/Experience:
- Experience with case management, utilization review, or prior authorization
- Familiarity with behavioral health settings
- Medical record abstracting skills
- Bilingual proficiency (English/Spanish)
Benefits
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 to $33.00 per hour
“Based on our compensation philosophy, 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
Visit us at Acentra.com/careers
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.