Acentra Health is hiring a remote Clinical Reviewer to support its mission of improving healthcare outcomes through technology-enabled services and clinical expertise. This role is perfect for licensed healthcare professionals who enjoy clinical decision-making, patient advocacy, and structured review processes — all while working fully from home. If you want meaningful work that has a direct impact on patient care across the country, this position offers a strong, stable path.
💼 Employment Type: Full-Time
📍 Location: Remote (U.S.)
💬 Job Overview
As a Clinical Reviewer (SCA), you’ll use your clinical expertise to evaluate cases, determine medical appropriateness, support beneficiary advocacy, and ensure compliance with contract requirements and regulatory standards.
You’ll work closely with providers, internal teams, and your supervisor to complete accurate and timely reviews, maintain quality benchmarks, and support continuous improvement across review processes.This role requires strong critical thinking, decision-making, and documentation skills, along with the ability to navigate multiple systems in a remote environment. If you love clinically focused work without bedside demands — and want to support better health outcomes nationwide — this job may be a great match.
📋 Key Responsibilities
Conduct accurate, timely clinical reviews according to contract requirements and internal QA standards.
Manage daily workloads, queues, and priorities to ensure deadlines and production goals are met.
Participate in quality monitoring activities; identify opportunities for process improvement.
Serve as the first point of contact for nurse reviewers regarding review process questions.
Act as provider liaison to support customer service, problem resolution, and proper review procedures.
Perform all applicable review types based on workload and contract needs.
Maintain up-to-date knowledge on clinical practices, review standards, NCQA requirements, and program updates.
Attend required training and meetings; stay current on all review-related policies and procedures.
Cross-train on other contracts to support flexible workforce needs.
Adhere to corporate policies, including HIPAA privacy and security requirements.
🧩 Requirements
Required Qualifications:
Active, unrestricted LPN, RN, Social Worker, or other applicable state clinical license.
Minimum 3 years of clinical experience in an acute or med-surgical setting.
Strong clinical assessment, critical thinking, and medical record abstracting skills.
Excellent verbal and written communication skills; strong professional judgment.
Proficiency with Microsoft Office and web-based platforms.
Preferred Qualifications:
Bachelor’s degree in a related field.
Experience in case management, utilization review, or prior authorization.
Background in behavioral health.
Bilingual candidates strongly preferred.
✨ Why You’ll Love This Job
This role offers meaningful, high-impact work without bedside physical demands, allowing you to use your clinical knowledge in a structured and supportive remote environment. Acentra Health values innovation, collaboration, and professional growth — providing opportunities to advance your skills while contributing to improved healthcare outcomes nationwide.
You’ll also enjoy robust benefits, a strong team culture, and the freedom to work fully from home.
🌟 Who This Job Is Perfect For
Licensed clinicians who enjoy analytical, review-based work.
Professionals seeking a non-bedside remote clinical career path.
Detail-oriented problem solvers who thrive in structured review environments.
Individuals passionate about patient advocacy and healthcare quality.
Remote workers who value stable, mission-driven roles with long-term growth potential.
🏢 About the Company
Acentra Health is a national leader in technology-driven healthcare services, partnering with federal and state agencies, providers, and employers to improve health outcomes. Their team includes clinicians, technologists, and industry experts dedicated to solving complex healthcare challenges.With strong benefits, remote flexibility, continuing education support, and a mission-centered culture, Acentra Health is a great place to build a long-term remote healthcare career.
🚀 How to Apply
You’ll be redirected to Acentra Health’s official careers site to submit your application.
