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 role is responsible for completing applicable review cases accurately and on time, managing daily workloads and queues, and adjusting schedules to meet departmental demands. In collaboration with a supervisor, the Clinical Reviewer participates in quality monitoring and maintains current knowledge of review processes and clinical practices. The position also supports provider customer-service issues and problem resolution, builds professional relationships with internal and external customers, attends training and meetings, cross-trains to support client needs, and adheres to corporate policies, including HIPAA Privacy and Security Rules.

Requirements

Active, unrestricted RN or Behavioral Health license in the Commonwealth of Virginia.
Bachelor's or Master's degree from an accredited college or university in a related field.
At least 1 year of experience in 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 accurate and timely completion of applicable review cases within contract requirements.
Assess, evaluate, and address daily workloads and queues; adjust work schedules to meet departmental 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 requires.
Foster positive and professional relationships with internal and external customers.
Attend training and scheduled meetings to stay informed of current and updated information.
Cross-train to provide a flexible workforce for client and customer needs.
Read, understand, and follow corporate policies, including HIPAA Privacy and Security Rules.