Clinical Reviewer-PRN (RN) (Remote)
About The Position
Acentra Health is looking for a Clinical Reviewer 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 is a remote position with on-call requirements for weekends, holidays, and evenings. Acentra Health is dedicated to empowering better health outcomes through technology, services, and clinical expertise, with a mission to innovate health solutions that deliver maximum value and impact. The company embraces emerging technologies like artificial intelligence and advanced analytics to improve processes and drive better health outcomes, valuing professionals who are curious about new technologies and motivated to use innovative tools.
Requirements
- Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state License.
- A minimum of 2+ years of experience with federal CMS case processing.
- Knowledge of medical records and medical terminology.
- 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.
Nice To Haves
- Knowledge of IRO Accreditation (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.
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.
Benefits
- Participation in the Acentra Health 401(k) Plan with company match
- Access to wellness programs
- Employee discount programs
- Employee Assistance Program (EAP) resources
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What This Job Offers
Career Level
Mid Level
