[Remote] Clinical Reviewer (LPN or RN)

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