Job Description
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Role Description
- Acentra Health is looking for a Clinical Reviewer - LPN/LVN or RN - PRN (remote U.S.) 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.
- This position is remote within the United States, but applicants must be clinically licensed for the State of Indiana or have a compact license.
- Work Schedule: May work up to 19 hours per week inclusive of weekends and/or holidays as required based on business need.
- Must be fully available to attend 100% of training, Monday through Friday, 9:00 AM – 6:00 PM EST, for a minimum of the first three weeks.
- 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.
- 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 LPN/LVN or RN license in the state of Indiana or a Compact state clinical license.
- Associate's degree (bachelor's preferred) or Practical/Professional nursing diploma from an accredited nursing school, college, or university.
- A minimum of 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience.
- A minimum of 2+ years of medical necessity review experience.
- A minimum of 1+ years of InterQual criteria and/or Milliman Care Guidelines (MCG) experience.
- Knowledge of medical records, medical terminology, and disease processes.
- Strong clinical assessment and critical thinking skills.
- Excellent written and verbal communication skills.
- Proficient in navigating multiple systems with the ability to switch between systems seamlessly and effectively.
- Flexibility and strong organizational skills.
- Requirements
- May work up to 19 hours per week inclusive of weekends and/or holidays as required based on business need.
- Must be fully available to attend 100% of training, Monday through Friday, 9:00 AM – 6:00 PM EST, for a minimum of the first three weeks.
- Preferred Qualifications
- 3+ years of clinical experience in an acute, behavioral health, and/or med-surgical environment.
- Knowledge of current National Committee for Quality Assurance (NCQA) standards.
- Knowledge of Utilization Review Accreditation Commission (URAC) standards.
- Ability to work in a team environment.
- Proficient in Microsoft Office.
- Efficient time management, including the ability to prioritize tasks, and meet deadlines.
- Exhibit the ability to maintain confidentiality standards and ensure HIPAA compliance when assessing relevant issues.
- Benefits
- Comprehensive health plans.
- Paid time off.
- Retirement savings.
- Corporate wellness.
- Educational assistance.
- Corporate discounts.
- And more.
Compensation
The pay range for this position is listed below: USD $28.37 - USD $39.19 /Hr. Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.
Thank You!
We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!
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