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 Acentra Health is seeking a dedicated and experienced Clinical Reviewer to join our growing and mission‑driven team. This role offers the opportunity to make a meaningful impact by supporting high‑quality healthcare decisions that improve outcomes for patients and communities. In this position, you will leverage your clinical expertise to review medical records, ensuring alignment with established clinical criteria, evidence‑based guidelines, and contractual requirements. Your work will play a critical role in supporting informed healthcare decisions, improving health outcomes, promoting quality care, and ensuring regulatory and contractual compliance. We currently have four Clinical Reviewer openings. Available schedules include one position with a Sunday‑Thursday, 8:00 AM‑5:30 PM schedule; one position with a Tuesday‑Saturday, 8:00 AM‑5:30 PM schedule; and two positions with a Monday‑Friday, 10:00 AM‑6:30 PM schedule. This is a remote, work‑from‑home position, and candidates must reside in California and must hold an active, unrestricted California LMFT or LCSW license. Job Responsibilities 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. Qualifications 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 processes. 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. Detail‑oriented with excellent organizational skills and the ability to prioritize and complete tasks efficiently within established timelines. Proficient in computer‑based software and tools, including Microsoft Office Suites; Word, Excel, Outlook, and Teams. 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 per hour - $40.00 per hour. Pay range: USD $28.37 - $39.19 per hour. Based on our 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. 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

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