[Hiring] Clinical Reviewer-RN @Acentra Health, LLC

Role Description

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

The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness.

• 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.
• 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

• Requires a Bachelor’s Degree and a minimum of 2 years of clinical experience.
• Active unrestricted RN in the applicable State and/or Compact State clinical license per contract requirements.
• Knowledge of the organization of medical records, medical terminology, and disease process required.
• Strong clinical assessment and critical thinking skills required.
• Medical record abstracting skills required.
• Requires excellent written and verbal communication skills.

Benefits

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness.
• Educational assistance.
• Corporate discounts.
• And more.