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 is looking for a Clinical Reviewer BFCC IA/QOC (LPN, RN, or SW) to join our growing team.

Job Summary:

The Clinical Reviewer utilizes clinical expertise to conduct beneficiary interactions and medical record reviews in alignment with contract requirements. Leveraging critical thinking and decision-making skills, the role ensures communication of medical appropriateness, supports care coordination, and maintains compliance with NCQA and regulatory standards. This position is key to ensuring high-quality healthcare delivery and achieving department goals.

Job Responsibilities:

Ensure accuracy and timeliness of medical record reviews as per contract requirements Monitor and manage daily workload to meet departmental demands effectively Provide care coordination, case management, and discharge planning support to beneficiaries and their representatives Assist in quality monitoring activities, including identifying improvement areas and implementing action plans Serve as a resource for nurse reviewers and liaise with providers to resolve customer service issues Maintain a strong knowledge base of clinical practices and review processes Foster professional relationships with internal and external stakeholders to facilitate seamless operations Participate in training and meetings to stay updated on review protocols and industry standards Cross-train to support other contracts as needed to ensure workforce flexibility