[Remote] Clinical Reviewer

Note: The job is a remote job and is open to candidates in USA. Acentra Health is dedicated to empowering better health outcomes through innovative solutions and clinical expertise. They are seeking a Clinical Reviewer to utilize clinical expertise in reviewing medical records against established criteria while ensuring accuracy and timeliness within contract requirements. 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 Maintains current knowledge base related to review processes and clinical practices Functions as providers' liaison for customer service issues and problem resolution Performs all applicable review types as workload indicates Fosters positive and professional relationships with internal and external customers Attends training and scheduled meetings for current/updated information Cross trains to provide 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 Skills Active unrestricted LPN, or RN required For LPN or Practical Nursing diploma or practical nursing certificate program, in accordance with state requirements For RN - Associate's or higher degree from an accredited college or university in a related field Knowledge of medical records, medical terminology, and disease processes required Strong clinical assessment and critical thinking skills required Excellent written and verbal communication skills required Knowledge of InterQual and/or MCG 1+ year experience in Utilization Review Benefits Comprehensive health plans Paid time off Retirement savings Corporate wellness Educational assistance Corporate discounts And more Company Overview Acentra Health is a provider of clinical services and technological solutions to government healthcare organizations. It was founded in 1994, and is headquartered in Mclean, Virginia, USA, with a workforce of 1001-5000 employees. Its website is