Clinical Reviewer RN - PRN

Acentra Health, LLC

114d • $28 - $37

About The Position

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. This position is remote and requires on-call work during weekends, holidays, and evenings.

Requirements

• Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state License.
• 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.

Nice To Haves

• 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.

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

• Comprehensive health plans
• Paid time off
• Retirement savings
• Corporate wellness
• Educational assistance
• Corporate discounts

What This Job Offers

• Career Level: Entry Level
• Education Level: Bachelor's degree