Note: The job is a remote job and is open to candidates in USA. Acentra Health is dedicated to empowering better health outcomes through technology and clinical expertise. They are seeking a Clinical Reviewer to assess medical records against criteria and contract requirements, ensuring accuracy and timeliness in reviews.
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 the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas
- Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns
- Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution
- Performs all applicable review types as workload indicates
- Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process
- Attends training and scheduled meetings and for maintenance and use of current/updated information for review
- Cross trains and perform duties of other contracts to provide a 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 Rule
Skills
- Licensed Practical Nurse (LPN) license or Registered Nurse (RN) license for the State of Virginia or compact license (will be required to obtain Virginia license within a year)
- For LPN - Associate's degree or Practical nursing diploma or practical nursing certificate program, in accordance with state requirements
- For RN - Bachelor's Degree from an accredited college or university in a related field
- 1+ year of experience in Prior Authorization, Utilization Review, or Utilization Management
- Must be able to work alternating weekends
- Knowledge of the organization of medical records, medical terminology, and disease process
- Strong clinical assessment and critical thinking skills
- Requires excellent written and verbal communication skills
- Medical record abstracting skills
Benefits
- Comprehensive health plans
- Paid time off
- Retirement savings
- Corporate wellness
- Educational assistance
- Corporate discounts
- And more
Company Overview
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