Acentra Health · 6 days ago
Clinical Reviewer - LPN/LVN or RN (remote U.S.)
United States
Full-time
Remote
Entry, Mid Level
$28.37/hr - $36.06/hr
2+ years expAcentra Health exists to empower better health outcomes through technology, services, and clinical expertise. The Clinical Reviewer will utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.
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 quality monitoring activities
Maintains current knowledge base related to review processes and clinical practices
Functions as providers' liaison for customer service issues and problem resolution
Performs all applicable review types as workload indicates
Fosters positive and professional relationships with internal and external customers
Attends training and scheduled meetings for current/updated information
Cross trains to provide 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/LVN or RN license in the state of Indiana or a Compact state clinical license
Associate's degree (bachelor's preferred) or Practical/Professional nursing diploma from an accredited nursing school, college, or university
2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience
2+ years of medical necessity review experience
1+ years of InterQual criteria and/or Milliman Care Guidelines (MCG) experience
Knowledge of medical records, medical terminology, and disease processes
Strong clinical assessment and critical thinking skills
Excellent written and verbal communication skills
Proficient in navigating multiple systems with the ability to switch between systems seamlessly and effectively
Flexibility and strong organizational skills
Preferred
3+ years of clinical experience in an acute, behavioral health, and/or med-surgical environment
Knowledge of current National Committee for Quality Assurance (NCQA) standards
Knowledge of Utilization Review Accreditation Commission (URAC) standards
Ability to work in a team environment
Proficient in Microsoft Office
Efficient time management, including the ability to prioritize tasks, and meet deadlines
Exhibit the ability to maintain confidentiality standards and ensure HIPAA compliance when assessing relevant issues
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