Clinical Reviewer

Acentra Health, LLC•Richmond, VA

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 position manages review cases and daily workload, supports quality monitoring, maintains knowledge of review processes and clinical practices, and serves as a provider liaison for customer service issues and problem resolution. The reviewer also builds professional relationships, participates in training and meetings, cross-trains to support workforce flexibility, and follows corporate policies, including HIPAA privacy and security requirements.

Requirements

Active, unrestricted RN or Behavioral Health license in the Commonwealth of Virginia.
Associate's degree from an accredited college or university in a related field.
At least 1 year of experience with Utilization Management.

Nice To Haves

Knowledge of medical records, medical terminology, and disease processes.
Strong clinical assessment and critical thinking skills.
Excellent written and verbal communication skills.

Responsibilities

Ensure the accuracy and timeliness of applicable review cases within contract requirements.
Assess, evaluate, and address daily workload and queues, adjusting work schedules to meet department workload demands.
Collaborate with the 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.