Clinical Reviewer-SCA

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

About The Position

Acentra Health seeks a Clinical Reviewer to review medical records against appropriate criteria and contract requirements to determine medical appropriateness. The role supports accurate, timely reviews while adapting daily work to changing workloads and department needs. The reviewer also supports quality monitoring and improvement, maintains current knowledge of review processes and relevant clinical practices, and serves as a resource for nurse reviewers and providers. The position involves collaborating with internal and external customers, attending training and meetings, cross-training across contracts, and following corporate policies, including HIPAA Privacy and Security Rules. Acentra Health describes its work as using technology, services, and clinical expertise to improve health outcomes, and values curiosity about emerging technologies such as artificial intelligence and advanced analytics. The listed pay range is USD $28.37–$35.00 per hour. Benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and other benefits.

Requirements

Active, unrestricted LPN, Social Worker, or other applicable state and/or compact-state clinical license.
For LPNs: an associate’s degree, practical nursing diploma, or practical nursing certificate program, in accordance with state requirements.
For RNs or Social Workers: a bachelor’s degree from an accredited college or university in a related field.
Knowledge of medical record organization, medical terminology, and disease processes.
Strong clinical assessment and critical thinking skills.
Excellent written and verbal communication skills.
Medical record abstracting skills.

Responsibilities

Ensure accuracy and timeliness of applicable review cases within contract requirements.
Assess and manage daily workload and queues, adjusting work schedules to meet department workload demands.
Collaborate with the Supervisor on quality monitoring, identifying areas for improvement, 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.
Foster 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 to maintain and use current information for reviews.
Cross-train and perform duties for other contracts to support workforce flexibility and client or customer needs.
Read, understand, and follow corporate policies, including HIPAA Privacy and Security Rules.