Clinical Reviewer - LPN/LVN (Remote U.S.)

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 Health is looking for a Clinical Reviewer - LPN/LVN (Remote U.S.) to join our growing team. Job Summary: Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with regulatory benchmarks, ensuring precision and compliance in medical record reviews.

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 related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns. Functions as providers' liaison for customer service issues and problem resolution. Performs all applicable review types as workload indicates. Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process. Attends training and scheduled meetings for current/updated information. Cross trains and perform duties 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. Work Schedule: Five eight-hour shifts with alternating weekends 9:00 AM to 6:00 PM Eastern