Note: The job is a remote job and is open to candidates in USA. Acentra Health is dedicated to empowering better health outcomes through innovative solutions and clinical expertise. They are seeking a Clinical Reviewer to utilize clinical expertise in reviewing medical records against established criteria while ensuring accuracy and timeliness within contract requirements.
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
- Active unrestricted LPN, or RN required
- For LPN or Practical Nursing diploma or practical nursing certificate program, in accordance with state requirements
- For RN - Associate's or higher degree from an accredited college or university in a related field
- Knowledge of medical records, medical terminology, and disease processes required
- Strong clinical assessment and critical thinking skills required
- Excellent written and verbal communication skills required
- Knowledge of InterQual and/or MCG
- 1+ year experience in Utilization Review
Benefits
- Comprehensive health plans
- Paid time off
- Retirement savings
- Corporate wellness
- Educational assistance
- Corporate discounts
- And more
Company Overview
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