Clinical Reviewer RN - Remote

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.

Join Acentra Health as an RN Clinical Reviewer and play a critical role in supporting priority populations while making a meaningful difference in the communities we serve. In this role, you will leverage your clinical expertise to review and assess medical records against established clinical criteria and contract requirements, helping ensure accurate, compliant, and high-quality outcomes. This is a full-time remote position offering the flexibility to work from your home office while contributing to work that truly matters.

You will be part of a mission-driven organization dedicated to improving health outcomes. Candidates must be available to work during regular business hours from 9:00 A.M. to 5:30 P.M. Eastern Time, with some flexibility for those located in the Central Time zone. Acentra Health provides the essential technology equipment for your home office, including a company-issued laptop.

• Ensure the accuracy, quality, and timeliness of all assigned case reviews in accordance with contract requirements and regulatory standards.
• Effectively manage daily workloads and review queues, adjusting schedules as needed to meet departmental demands and turnaround times.
• Collaborate with the Supervisor on quality monitoring and improvement initiatives to support compliance and performance excellence.
• Maintain up-to-date knowledge of clinical practices, review criteria, and assessment processes to ensure informed and consistent decision-making.
• Serve as a clinical liaison to providers, addressing customer service inquiries and supporting issue resolution in a professional and timely manner.
• Perform all applicable review types as required based on workload volume and business needs.
• Build and maintain positive, professional relationships with both internal teams and external stakeholders.
• Participate in required training sessions and scheduled meetings to stay current on policies, procedures, and process updates.
• Cross-train as needed to provide workforce flexibility and support evolving client and customer needs.
• Understand and adhere to all corporate policies, including those related to HIPAA and its Privacy and Security Rules.
• Maintain compliance with established workflows, regulatory requirements, and best-practice standards.

Required Qualifications & Experience

• Active, unrestricted Registered Nurse (RN) license in good standing, with an Associate s degree (Bachelor s degree preferred) or completion of an accredited professional nursing diploma program.
• Strong clinical assessment, analytical, and critical-thinking skills with the ability to make sound, evidence-based decisions.
• Working knowledge of medical records review, medical terminology, and disease processes.
• Strong written and verbal communication skills, with the ability to clearly document and explain clinical findings.
• Detail-oriented with excellent organizational skills and the ability to prioritize and complete tasks efficiently within established timeline.

Preferred Qualifications & Experience

• Experience working for an Independent Review Organization (IRO) or in a similar clinical review setting.
• Familiarity with URAC accreditation standards and regulatory requirements.
• Knowledge of public mental health systems and government-sponsored medical programs is preferred.
• Prior experience working in a remote or virtual clinical environment.
• Proficiency in computer-based applications and the Microsoft Office Suite, including Word, Excel, Outlook, and Teams.

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.

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!

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

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