Clinical Reviewer - (Remote in California)

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 Health is looking for a Clinical Reviewer to join our growing team.

Job Summary

Acentra Health is seeking a dedicated and experienced Clinical Reviewer to join our growing and mission-driven team. his is a meaningful and impactful role with a fantastic team of healthcare professionals. We are seeking detail-oriented, motivated, and organized professionals who are committed to quality, compliance, and accuracy. This is a remote, work-from-home position; however, candidates must reside in the state of California and hold an active California LMFT or LCSW license to be considered.

In this position, you will leverage your clinical expertise to conduct reviews of medical records, ensuring alignment with established clinical criteria, evidence-based guidelines, and contractual requirements. Your work will play an important role in supporting informed healthcare decisions, promoting quality care, and ensuring regulatory and contractual compliance.

• Ensure the accuracy, quality, and timeliness of all assigned review cases in accordance with contractual and regulatory requirements.
• Proactively assess, prioritize, and manage daily workloads and review queues, adjusting work schedules as needed to effectively meet departmental demands.
• Collaborate with the Supervisor to support and participate in ongoing quality monitoring and performance improvement initiatives.
• Maintain current knowledge of clinical practices, evidence-based guidelines, and internal review processes to ensure high-quality, compliant reviews.
• Serve as a liaison to healthcare providers by addressing customer service inquiries and facilitating effective problem resolution.
• Perform all applicable types of clinical reviews as dictated by workload volume and business needs.
• Build and sustain positive, professional working relationships with both internal teams and external stakeholders.
• Participate in required training sessions and scheduled meetings to remain informed of process updates, policy changes, and organizational initiatives.
• Cross-train across functions to support a flexible workforce and ensure continuity in meeting client and customer needs.
• Read, understand and adhere to all corporate policies and procedures, including full compliance with HIPAA Privacy and Security regulations.

Required Qualifications, Skills and Experience

• Must hold an active California license as a Licensed Marriage and Family Therapist (LMFT) or Licensed Clinical Social Worker (LCSW) and a master's degree in a directly related field from an accredited institution.
• Demonstrated knowledge of medical records review, medical terminology, and common disease

• Experienced in performing clinical reviews to ensure established criteria are met, maintaining accuracy in inpatient documentation, and adhering to all compliance guidelines and contractual obligations.

• Skilled in conducting utilization reviews and patient chart reviews with accuracy and timeliness.

• Strong clinical assessment, analytical, and critical-thinking skills with the ability to apply evidence-based criteria.

• Excellent written and verbal communication skills, with the ability to effectively collaborate with providers, peers, and stakeholders.

• Proficient in computer-based software and tools, including Microsoft Office Suites; Word, Excel, Outlook, and Teams.

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 nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career.

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

EEO 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, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

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 compensation for this role is $35.00 hour $40.00 per hour

Based on ou0r 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.

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