Clinical Reviewer-RN
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 supports accurate and timely case reviews, manages daily workload and queues, and contributes to quality monitoring and improvement activities. The reviewer maintains current knowledge of review processes and clinical practices, supports nurse reviewers with process questions, and serves as a liaison for providers and other internal and external customers. The position may include performing different types of reviews and cross-training on other contracts to meet client and customer needs.
Requirements
- Bachelor’s degree and a minimum of 2 years of clinical experience.
- Active, unrestricted RN license in the applicable state and/or compact state, as required by the contract.
- Knowledge of medical record organization, medical terminology, and disease processes.
- Strong clinical assessment and critical thinking skills.
- Excellent written and verbal communication skills.
Nice To Haves
- Utilization Management (UM) experience.
- Experience utilizing InterQual Criteria.
- Medical record abstracting skills.
Responsibilities
- Ensure accuracy and timeliness of applicable case reviews within contract requirements.
- Assess and address daily workloads and queues, adjusting work schedules to meet department workload 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, and serve as an initial resource for nurse reviewers’ process questions and concerns.
- Serve as a provider liaison and contact or resource for provider customer service issues and problem resolution.
- Perform applicable review types as workload requires.
- Build and maintain professional relationships with internal and external customers to support effective working relationships and the review process.
- Attend training and scheduled meetings to maintain and use current review information.
- Cross-train and perform duties for other contracts to support a flexible workforce and meet client and customer needs.
Benefits
- Comprehensive health plans
- Paid time off
- Retirement savings
- Corporate wellness
- Educational assistance
- Corporate discounts
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
