CAP POC Reviewer

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.

At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles.

Acentra Health is looking for a CAP POC Reviewer to join our growing team.

Job Summary:

• The HCBS Plan of Care Reviewer is responsible for reviewing, evaluating, and processing Home and Community-Based Services (HCBS) waiver requests, Plans of Care, reassessments, and related documentation to ensure compliance with Medicaid policy, waiver requirements, contractual obligations, and program standards. .

Responsibilities:

• Reviews records and documentation for contractual, regulatory, and organizational compliance.
• Ensures assigned reviews are accurate, complete, and completed on time.
• Documents findings, trends, concerns, and recommendations for leadership and stakeholders.
• Participates in quality assurance, compliance monitoring, audits, and process improvement.
• Identifies documentation gaps and supports corrective actions and process enhancements.
• Maintains accurate tracking records for reviews, findings, and follow-up activities.
• Manages workloads, prioritizes assignments, and adjusts workflows to meet operational needs.
• Supports special projects, cross-training, workforce flexibility, and departmental continuity.
• Advises staff and serves as a liaison among departments, providers, partners, and stakeholders.
• Builds professional relationships and promotes teamwork, accountability, and customer service.
• Maintains current knowledge of policies, procedures, program requirements, and training updates.
• Protects confidential information, follows HIPAA and organizational requirements, and reports compliance or security concerns.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Required Qualifications

• Bachelor's degree from an accredited college or university in Healthcare Administration, Business Administration, Public Health, Human Services, Social Services, Quality Management, or a related field.
• Minimum of two years of experience in quality assurance, compliance, healthcare operations, program administration, auditing, documentation review, customer service, or a related field.
• Experience interpreting and applying policies, procedures, contractual requirements, or program standards
• Excellent written and verbal communication skills.
• Strong analytical, critical-thinking, and problem-solving skills.
• Strong attention to detail with a commitment to accuracy and quality.
• Ability to work independently, prioritize tasks, and manage multiple projects simultaneously in a fast-paced environment.

Preferred Qualifications

• Master's Degree from an accredited college or university in a related field.
• Experience working in a regulated environment.
• Knowledge of and experience reviewing and participating in legal claims or polices from a clinical perspective.
• Proficiency with Microsoft Office applications and other systems required to perform assigned responsibilities.
• Ability to establish and maintain positive working relationships with internal and external stakeholders.
• Ability to communicate concerns and recommendations professionally.
• Ability to collaborate effectively in a team environment.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

We are committed to providing a secure and positive hiring experience. Depending on the role, interviews may be conducted virtually, in person, or through a combination of both. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process.

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."