Clinical Reviewer-SCA

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

2d•Remote

About The Position

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles. Job Summary: The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness.

Requirements

Active unrestricted LPN or, Social Worker or other applicable State and/or Compact State clinical license
For LPN - Associate's degree or Practical nursing diploma or practical nursing certificate program, in accordance with state requirements.
For RN or SW - Bachelor's Degree from an accredited college or university in a related field.
Knowledge of the organization of medical records, medical terminology, and disease process required
Strong clinical assessment and critical thinking skills required
Requires excellent written and verbal communication skills
Medical record abstracting skills required

Nice To Haves

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

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 the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas
Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns
Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution
Performs all applicable review types as workload indicates
Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process
Attends training and scheduled meetings and for maintenance and use of current/updated information for review
Cross trains and perform duties of other contracts to provide a 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.