Clinical Reviewer-RN

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

About The Position

Acentra Health is seeking a Clinical Reviewer-RN to review medical records against appropriate criteria and contract requirements to determine medical appropriateness. The role ensures reviews are accurate and timely, manages daily workloads and queues, supports quality monitoring and improvement, and maintains current knowledge of review processes and related clinical practices. The Clinical Reviewer-RN also serves as a resource for nurse reviewers and as a liaison for providers and other internal and external customers. The position may perform different review types and duties across contracts as workload and customer needs require.

Requirements

Associate's or bachelor's degree.
At least 2 years of recent clinical experience.
Experience using InterQual for medical necessity reviews.
Active, unrestricted RN license in Indiana and/or a multistate compact license.
Medical record abstracting skills.
Strong clinical assessment and critical thinking skills.
Excellent written and verbal communication skills.

Nice To Haves

Emergency room or medical/surgical experience preferred.
Knowledge of medical record organization, medical terminology, and disease processes.

Responsibilities

Ensure the accuracy and timeliness of applicable case reviews within contract requirements.
Assess and manage daily workload and queues, adjusting work schedules to meet department demands.
Collaborate with the Supervisor on quality monitoring, identifying improvement areas, and implementing improvement plans.
Maintain current knowledge of review processes and related clinical practices; serve as an initial resource for nurse reviewers with process questions or concerns.
Serve as a provider liaison and contact/resource for provider customer service issues and problem resolution.
Perform applicable review types as workload requires.
Build positive, professional relationships and act as a liaison with internal and external customers to support effective working relationships and the review process.
Attend training and scheduled meetings and maintain and use current review information.
Cross-train and perform duties for other contracts to provide workforce flexibility and meet client and customer needs.
Perform other education- and experience-related duties as management may deem necessary.