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 is looking for a Clinical Reviewer-Immediate Advocacy/Quality of Care (RN) to join our growing team.

Job Summary:

The Clinical Reviewer is responsible for reviewing medical records to assess medical appropriateness based on established criteria and contract requirements. This role ensures the accuracy and timeliness of case reviews, collaborates on quality monitoring activities, and serves as a liaison for healthcare providers to resolve service-related issues. Located within the Care Management & Quality Oversight department, this position plays a critical part in supporting Acentra Health’s mission to improve health outcomes through technology and clinical expertise.

Job Responsibilities:

Ensure the accuracy and timely completion of case reviews in line with contract requirements Assess daily workloads and adjust schedules as needed to meet departmental demands Collaborate with the Supervisor on quality monitoring, identifying areas for improvement, and implementing enhancements Maintain current knowledge of review processes and clinical practices to provide guidance to nurse reviewers Act as a liaison for healthcare providers, addressing customer service issues and facilitating effective communication Conduct various review types based on workload requirements Foster positive and professional relationships with internal and external stakeholders to support the review process Attend training and meetings to stay updated on review protocols Cross-train on other contracts to support workforce flexibility and meet client needs