Acentra Health · 8 hours ago
Clinical Reviewer RN - Remote
United States
Full-time
Remote
Mid Level
$33/hr - $37/hrAcentra Health is dedicated to empowering better health outcomes through technology and clinical expertise. They are seeking an RN Clinical Reviewer to leverage clinical expertise in reviewing and assessing medical records, ensuring compliance and high-quality outcomes for priority populations.
Health Care
Responsibilities
Ensure the accuracy, quality, and timeliness of all assigned case reviews in accordance with contract requirements and regulatory standards
Effectively manage daily workloads and review queues, adjusting schedules as needed to meet departmental demands and turnaround times
Collaborate with the Supervisor on quality monitoring and improvement initiatives to support compliance and performance excellence
Maintain up-to-date knowledge of clinical practices, review criteria, and assessment processes to ensure informed and consistent decision-making
Serve as a clinical liaison to providers, addressing customer service inquiries and supporting issue resolution in a professional and timely manner
Perform all applicable review types as required based on workload volume and business needs
Build and maintain positive, professional relationships with both internal teams and external stakeholders
Participate in required training sessions and scheduled meetings to stay current on policies, procedures, and process updates
Cross-train as needed to provide workforce flexibility and support evolving client and customer needs
Understand and adhere to all corporate policies, including those related to HIPAA and its Privacy and Security Rules
Maintain compliance with established workflows, regulatory requirements, and best-practice standards
Qualification
Required
Active, unrestricted Registered Nurse (RN) license in good standing, with an Associate's degree (Bachelor's degree preferred) or completion of an accredited professional nursing diploma program
Strong clinical assessment, analytical, and critical-thinking skills with the ability to make sound, evidence-based decisions
Working knowledge of medical records review, medical terminology, and disease processes
Strong written and verbal communication skills, with the ability to clearly document and explain clinical findings
Detail-oriented with excellent organizational skills and the ability to prioritize and complete tasks efficiently within established timeline
Preferred
Experience working for an Independent Review Organization (IRO) or in a similar clinical review setting
Familiarity with URAC accreditation standards and regulatory requirements
Knowledge of public mental health systems and government-sponsored medical programs is preferred
Prior experience working in a remote or virtual clinical environment
Proficiency in computer-based applications and the Microsoft Office Suite, including Word, Excel, Outlook, and Teams
Benefits
Comprehensive health plans
Paid time off
Retirement savings
Corporate wellness
Educational assistance
Corporate discounts
And more
Company
Acentra Health
Acentra Health is a provider of clinical services and technological solutions to government healthcare organizations.
Founded in 1994
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