[Hiring] Clinical Reviewer @Acentra Health, LLC

Role Description

Acentra Health is looking for a PRN Clinical Reviewer to join our growing team.

The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.

• 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.

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.

Qualifications

• Active, unrestricted RN license for the State of North Dakota or compact/multi-state.
• Associate's degree (bachelor's preferred) from an accredited college or university in a related field.
• 2+ years of clinical experience.

Requirements

• Experience using InterQual or MCG for medical necessity review.
• Experience with inpatient, DME, or Hospice services.
• Knowledge of medical records, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.
• Excellent written and verbal communication skills.

Benefits

• Participation in the Acentra Health 401(k) Plan with company match.
• Access to wellness and employee discount programs.
• Employee Assistance Program (EAP) resources.