Job Description

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 and Responsibilities:

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

Job Summary:

Join Acentra Health as a Clinical Reviewer and make a meaningful impact in the communities we serve. In this vital role, you will leverage your clinical expertise to conduct comprehensive medical record reviews, ensuring alignment with established clinical criteria and contract requirements. Your work will directly support accurate determinations, regulatory compliance, and the delivery of high-quality healthcare outcomes.

As a valued member of our team, you will focus on meeting production targets while consistently upholding the highest quality assurance standards This full-time, remote position offers the opportunity to contribute your clinical knowledge in a mission-driven environment while serving the state of Maine. (Must be a resident of the State of Maine)

Job Responsibilities

• Ensure the accuracy and timeliness of all assigned review cases in accordance with contract requirements and regulatory standards.
• Assess, evaluate and manage daily workloads and review queues to meet the workload demands of the department.
• In collaboration with the Supervisor to support and participate in quality monitoring and continuous improvement initiatives.

• Maintain current knowledge of clinical guidelines, review criteria, regulatory requirements, and industry best practices.

• Serve as a liaison to providers, delivering responsive customer service and facilitating timely issue resolution.

• Perform all applicable review types based on operational needs and workload distribution.

• Cultivate and maintain positive, professional relationships with internal teams and external stakeholders.

• Cross-train across functions to support a flexible and adaptable workforce that meets evolving client and customer needs.

• Participate in required trainings, team meetings, and professional development activities to remain informed of updates and organizational changes.

• Read, understand, and comply with all corporate policies and procedures, including strict adherence to HIPAA Privacy and Security regulations.

Qualifications:

Required Qualifications, Knowledge, and Experience

• Active, unrestricted Licensed Clinical Professional Counselor or Licensed Clinical Social Worker required.

• Familiarity with public sector healthcare services and support systems.
• (Must be a resident of the State of Maine)

• Working knowledge of medical records and medical terminology.

• Strong written and verbal communication skills, with the ability to clearly document, articulate, and explain clinical findings.

Preferred Qualifications

• Detail-oriented with strong organizational skills and the ability to prioritize, manage multiple responsibilities, and meet established deadlines.
• Proficiency in computer systems and web-based platforms necessary to perform job responsibilities effectively.
• Working knowledge of Microsoft Office Suite, including 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 across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

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 pay range for this position is listed below. 

“Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”

Thank You!

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.

Pay Range: USD $28.37 - USD $39.19 /Hr.

Job Tags

Full time, Contract work, Work at office, Local area, Remote work, Flexible hours

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