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 - RN (Personal Care) to utilize clinical expertise in reviewing medical records against criteria and collaborating with team members to ensure compliance and quality in personal care services. 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. • 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. • Conducts initial and prior authorization for Personal Care services. • Evaluates the quality and compliance of service documentation in client records, ensuring adherence to Arkansas Medicaid regulations. • Refers cases to the Physician Reviewer for medical necessity determinations when appropriate. • Serves as a liaison between the organization throughout the review process. • Provides education on the Reconsideration and Appeal process. • Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Skills • Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license. • Associate’s, Bachelor's degree (or Diploma) in Nursing. • 2+ years of clinical experience in an acute OR home health environment. • 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. • 1+ years of knowledge of medical records, medical terminology, and disease process organization. • Knowledge of Medicaid guidelines. • Medical Record Abstracting skills. • Clinical assessment and critical thinking skills. • Excellent verbal and written communication skills. • Ability to work in a team environment. • Flexibility and strong organizational skills. • Proficient in Microsoft Office and Internet/Web Navigation. • Experience working in a Remote environment. 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 Apply tot his job