Clinical Reviewer (LPN, LVN, RN)

Company Overview 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. Job Summary The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness. The selected candidate will typically work Monday‑Friday from 8:00 AM – 5:00 PM Eastern and from 10:00 AM – 7:00 PM Eastern on one day, every other week, as assigned. 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, including identifying areas of improvement and plan implementation of improvement areas. Maintains current knowledgebase related to review processes and clinical practices related to the review processes, functions as the internal resource to nurse reviewers regarding all review process questions and/or concerns. Functions as provider 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 liaises with internal and external customers to ensure effective working relationships and team building to facilitate the review process. Attends training and scheduled meetings for maintenance and use of current/updated information for review. Cross‑trains and performs 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. Required Qualifications Active, unrestricted Licensed Practical Nurse (LPN) license, Licensed Vocational Nurse (LVN) license, or Registered Nurse (RN) license from the state where you reside, per contract/state requirements. Associate’s degree or practical/vocational nursing diploma or nursing certificate program, in accordance with state requirements. 1+ years Utilization Management/Utilization Review experience. Medical record abstracting skills, including knowledge of medical record organization, medical terminology, and disease processes. Strong clinical assessment and critical thinking skills. Preferred Qualifications Bachelor's Degree from an accredited college or university in a related field. 1+ years Private Duty Nursing or Home Health experience. Excellent written and verbal communication skills. Experience in Lieu of Degree For non‑clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands‑on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate’s degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor’s degree. 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. Pay Range USD $28.37 – USD $35.00 /Hr. EEO Statement Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. #J-18808-Ljbffr Acentra Health