Clinical Reviewer - LCPC or LCSW (Remote)

Acentra Health, LLC

11h•Remote

About The Position

Acentra Health empowers better health outcomes through technology, services, and clinical expertise, with a mission to innovate health solutions that deliver maximum value and impact. The company encourages employees to 'Lead the Way' by actively engaging in problem-solving and taking ownership of their work. Joining Acentra Health as a Clinical Reviewer offers an opportunity to make a meaningful impact by leveraging clinical expertise to conduct comprehensive medical record reviews. This role ensures alignment with established clinical criteria and contract requirements, directly supporting accurate determinations, regulatory compliance, and the delivery of high-quality healthcare outcomes. As a full-time, remote position, the Clinical Reviewer will focus on meeting production targets while upholding the highest quality assurance standards, specifically serving the state of Maine. Residency in the State of Maine is required.

Requirements

Active, unrestricted Licensed Clinical Professional Counselor or Licensed Clinical Social Worker required.
Graduate from an accredited Master's Degree Program
Must be a resident of the State of Maine
Familiarity with public sector healthcare services and support systems.
LCPC or LPSW in the State of Maine
Working knowledge of medical records and medical terminology.
Strong written and verbal communication skills, with the ability to clearly document, articulate, and explain clinical findings.

Nice To Haves

Detail-oriented with strong organizational skills and the ability to prioritize, manage multiple responsibilities, and meet established deadlines.
Proficiency in computer systems and web-based platforms necessary to perform job responsibilities effectively.
Working knowledge of Microsoft Office Suite, including Word, Excel, Outlook, and Teams.

Responsibilities

Ensure the accuracy and timeliness of all assigned review cases in accordance with contract requirements and regulatory standards.
Assess, evaluate and manage daily workloads and review queues to meet the workload demands of the department.
In collaboration with the Supervisor to support and participate in quality monitoring and continuous improvement initiatives.
Maintain current knowledge of clinical guidelines, review criteria, regulatory requirements, and industry best practices.
Serve as a liaison to providers, delivering responsive customer service and facilitating timely issue resolution.
Perform all applicable review types based on operational needs and workload distribution.
Cultivate and maintain positive, professional relationships with internal teams and external stakeholders.
Cross-train across functions to support a flexible and adaptable workforce that meets evolving client and customer needs.
Participate in required trainings, team meetings, and professional development activities to remain informed of updates and organizational changes.
Read, understand, and comply with all corporate policies and procedures, including strict adherence to HIPAA Privacy and Security regulations.