Job Description
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 Acentra Health is a provider of clinical services and technological solutions to government healthcare organizations.
It was founded in 1994, and is headquartered in Mclean, Virginia, USA, with a workforce of 1001-5000 employees. Its website is