Clinical Reviewer
About The Position
Acentra Health is seeking a Clinical Reviewer to use clinical expertise to review medical records against appropriate criteria and contract requirements. The role ensures accurate and timely case reviews, manages daily workloads and queues, and contributes to quality monitoring in collaboration with a supervisor. The Clinical Reviewer maintains current knowledge of review processes and clinical practices, supports providers with customer service issues and problem resolution, and performs applicable review types as workload requires. The position also involves building professional relationships with internal and external customers, attending training and meetings, cross-training to support client needs, and following corporate policies, including HIPAA privacy and security requirements.
Requirements
- Active, unrestricted LPN or RN license.
- For LPN candidates: associate degree, practical nursing diploma, or practical nursing certificate program, in accordance with state requirements.
- Knowledge of medical records, medical terminology, and disease processes.
- Strong clinical assessment and critical thinking skills.
- Excellent written and verbal communication skills.
Nice To Haves
- For RN candidates: bachelor's degree from an accredited college or university in a related field.
Responsibilities
- Ensure accuracy and timeliness of applicable review cases within contract requirements.
- Assess, evaluate, and address daily workload and queues; adjust work schedules to meet department workload demands.
- Collaborate with a supervisor on quality monitoring activities.
- Maintain current knowledge of review processes and clinical practices.
- Serve as a provider liaison for customer service issues and problem resolution.
- Perform applicable review types as workload indicates.
- Foster positive and professional relationships with internal and external customers.
- Attend training and scheduled meetings to receive current and updated information.
- Cross-train to provide a flexible workforce that meets client and customer needs.
- Read, understand, and adhere to corporate policies, including HIPAA Privacy and Security Rules.
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
Education Level
Associate degree
