Clinical Reviewer-Immediate Advocacy/Quality of Care (RN), Remote

CNSI and Kepro are now Acentra Health!  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 to join our growing team.

Job Summary:

The Clinical Reviewer (RN) plays a vital role within the Care Management & Quality Oversight department, utilizing clinical expertise to review medical records and evaluate them against established criteria and contract requirements. This role requires strong critical thinking and decision-making skills to assess medical appropriateness and support healthcare outcomes. The reviewer will be a key resource for clinical review processes and act as a liaison for provider and customer service issues.

Job Responsibilities:

• Ensure the accuracy and timeliness of reviews for all applicable case types within contract requirements
• Assess and manage daily workload and queues, adjusting work schedules as needed to meet departmental demands
• Collaborate with the supervisor to conduct quality monitoring activities, identify areas for improvement, and implement strategies to address these areas
• Maintain an up-to-date knowledge base related to clinical review processes and serve as the initial resource for other nurse reviewers
• Act as a liaison for providers, addressing customer service issues and ensuring problem resolution
• Perform reviews for all applicable case types as required by workload demands
• Foster positive relationships with internal and external stakeholders to enhance team effectiveness and the review process
• Attend ongoing training sessions and meetings to stay updated on review protocols and industry practices
• Cross-train in other contracts to maintain workforce flexibility in response to client needs

Requirements

• Active, unrestricted RN license (or LPN/Social Worker as per contract requirements)
• Bachelor’s Degree in a related field from an accredited institution
• Strong clinical assessment and critical thinking skills
• Knowledge of medical records organization, medical terminology, and disease processes
• Excellent written and verbal communication skills
• Experience in medical record abstracting

Preferred Qualifications/Experience:

• Familiarity with quality improvement processes in healthcare settings
• Previous experience in a care management or quality oversight role
• Additional certifications relevant to clinical review or quality oversight

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 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

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.