Clinical Reviewer, RN – Utilization Management

Acentra Health; United States; On-site; USD 39,000 - 54,000; Full time

Job summary

Acentra Health in the United States is seeking a Clinical Reviewer to apply clinical expertise to review medical records against contract criteria and ensure alignment with requirements.

The role emphasizes accuracy, timely processing, and ongoing quality monitoring, with duties spanning collaboration with supervisors, policy adherence, and provider/client liaison work across the health services landscape.

Qualifications

• Active unrestricted RN, or Behavioral Health license in the Commonwealth of Virginia required.
• Associate's degree from an accredited college or university in a related field.
• 1+ years' experience with Utilization Management

Responsibilities

• 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.
• Functions as providers' liaison for customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Fosters positive and professional relationships with internal and external customers.
• Attends training and scheduled meetings for current/updated information.
• Cross trains 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.

Skills

Clinical assessment

Communication skills

Critical thinking

Education

Associate's degree

Tools

Utilization Management systems

Job description

Acentra Health in the United States is seeking a Clinical Reviewer to apply clinical expertise to review medical records against contract criteria and ensure alignment with requirements.

The role emphasizes accuracy, timely processing, and ongoing quality monitoring, with duties spanning collaboration with supervisors, policy adherence, and provider/client liaison work across the health services landscape.