Clinical Reviewer (LMFT or LCSW) - Remote in CA

Acentra Health, LLC•UNAVAILABLE, California

3d•Remote

About The Position

Acentra Health is seeking a dedicated and experienced Clinical Reviewer to join our growing and mission-driven team. In this position, you will leverage your clinical expertise to review medical records, ensuring alignment with established clinical criteria, guidelines, and contractual requirements. This is a remote position, and candidates must live in California and hold an active, unrestricted California LMFT or LCSW license. This role offers the opportunity to make a meaningful impact by supporting high-quality healthcare decisions that improve outcomes for patients and communities.

Requirements

Must hold an active California license as a Licensed Marriage and Family Therapist (LMFT) or Licensed Clinical Social Worker (LCSW) and a master’s degree in a directly related field from an accredited institution.
Demonstrated knowledge of medical records review, medical terminology, and common disease
Experienced in performing clinical reviews to ensure established criteria are met, maintaining accuracy in inpatient documentation, and adhering to all compliance guidelines and contractual obligations.
Skilled in conducting utilization reviews and patient chart reviews with accuracy and timeliness.
Strong clinical assessment, analytical, and critical-thinking skills with the ability to apply evidence-based criteria.
Excellent written and verbal communication skills, with the ability to effectively collaborate with providers, peers, and stakeholders.
Detail-oriented with excellent organizational skills and the ability to prioritize and complete tasks efficiently within established timelines.
Proficient in computer-based software and tools, including Microsoft Office Suites; Word, Excel, Outlook, and Teams.

Responsibilities

Ensure the accuracy, quality, and timeliness of all assigned review cases in accordance with contractual and regulatory requirements.
Proactively assess, prioritize, and manage daily workloads and review queues, adjusting work schedules as needed to effectively meet departmental demands.
Collaborate with the Supervisor to support and participate in ongoing quality monitoring and performance improvement initiatives.
Maintain current knowledge of clinical practices, evidence-based guidelines, and internal review processes to ensure high-quality, compliant reviews.
Serve as a liaison to healthcare providers by addressing customer service inquiries and facilitating effective problem resolution.
Perform all applicable types of clinical reviews as dictated by workload volume and business needs.
Build and sustain positive, professional working relationships with both internal teams and external stakeholders.
Participate in required training sessions and scheduled meetings to remain informed of process updates, policy changes, and organizational initiatives.
Cross-train across functions to support a flexible workforce and ensure continuity in meeting client and customer needs.
Read, understand and adhere to all corporate policies and procedures, including full compliance with HIPAA Privacy and Security regulations.