Acentra Health · 1 month ago
Clinical Reviewer (SCA) - Remote
United States
Full-time
Remote
Mid Level
$27/hr - $33/hr
3+ years expAcentra Health is dedicated to empowering better health outcomes through technology and clinical expertise. They are seeking a Clinical Reviewer (SCA) to utilize clinical expertise during beneficiary interactions and ensure compliance with contract requirements and regulatory standards while maintaining production goals and quality assurance. The role involves assessing daily workloads, monitoring quality, and fostering relationships with internal and external customers.
Health Care
Responsibilities
Assures accuracy and timeliness of all applicable review type cases within contract requirements
Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department
In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas
Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns
Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution
Performs all applicable review types as workload indicates
Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process
Attends training and scheduled meetings and for maintenance and use of current/updated information for review
Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules
Qualification
Required
Active unrestricted LPN, RN or, Social Worker or other applicable State and/or Compact State clinical license
Minimum three years of clinical experience in an acute or med-surgical environment
Strong clinical assessment and critical thinking skills required
Excellent written and verbal communication skills
Must be proficient in Microsoft Office and Internet/web navigation
Preferred
Bachelor's Degree from an accredited college or university in a related field
Medical record abstracting skills
Some knowledge of Case Management, UR and/or Prior Authorization or related experience
Experience in a behavioral health setting
Bilingual
Benefits
Comprehensive health plans
Paid time off
Retirement savings
Corporate wellness
Educational assistance
Corporate discounts
Company
Acentra Health
Acentra Health is a provider of clinical services and technological solutions to government healthcare organizations.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2022-11-09Acquired
Leadership Team
Todd Stottlemyer
Chief Executive Officer
Grant Christie
Senior Vice President, Market Strategy and Solutions
Recent News
2026-01-13
Company data provided by crunchbase