Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.
Clinical Reviewer RN
Location
United States
Posted
9 days ago
Salary
$28 - $38 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Role Description
Acentra Health is looking for a Clinical Reviewer RN - PRN 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.
Position is remote
Required Work Hours: On-call weekends, holidays and evenings
- 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 Registered Nurse (RN) License in any state, or an RN compact state License.
- A minimum of 2+ years of clinical experience in an acute OR med-surgical environment.
- Knowledge of medical records, medical terminology, and disease process organization.
- Skilled in reviewing, interpreting, and abstracting data from medical records.
- Strong clinical assessment and critical thinking skills.
- Excellent verbal and written communication skills.
- Must be proficient in Microsoft Office and internet/web navigation.
Requirements
- Bachelor's Degree from an accredited college or university in a related field.
- Knowledge of current National Committee for Quality Assurance (NCQA) standards.
- Knowledge of Utilization Review Accreditation Commission (URAC) standards.
- Knowledge of Independent Review Organization (IRO).
- Knowledge of Medicare (CMS) guidelines.
- Experience with Medical Appeals.
- Ability to work in a team environment.
- Flexibility and strong organizational skills.
Benefits
- Access to select Acentra Health benefits and programs.
- Participation in the Acentra Health 401(k) Plan with company match.
- Access to wellness and employee discount programs.
- Employee Assistance Program (EAP) resources.
Job Requirements
- Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state License.
- A minimum of 2+ years of clinical experience in an acute OR med-surgical environment.
- Knowledge of medical records, medical terminology, and disease process organization.
- Skilled in reviewing, interpreting, and abstracting data from medical records.
- Strong clinical assessment and critical thinking skills.
- Excellent verbal and written communication skills.
- Must be proficient in Microsoft Office and internet/web navigation.
- Bachelor's Degree from an accredited college or university in a related field.
- Knowledge of current National Committee for Quality Assurance (NCQA) standards.
- Knowledge of Utilization Review Accreditation Commission (URAC) standards.
- Knowledge of Independent Review Organization (IRO).
- Knowledge of Medicare (CMS) guidelines.
- Experience with Medical Appeals.
- Ability to work in a team environment.
- Flexibility and strong organizational skills.
Benefits
- Access to select Acentra Health benefits and programs.
- Participation in the Acentra Health 401(k) Plan with company match.
- Access to wellness and employee discount programs.
- Employee Assistance Program (EAP) resources.
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