Clinical Reviewer

Acentra Health, LLC

11h•$28 - $35

About The Position

Acentra Health is looking for a Clinical Reviewer to join our growing team. The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.

Requirements

Active unrestricted LPN, RN license required.
For LPN - Practical nursing diploma or practical nursing certificate program, in accordance with state requirements.
For RN - Associate' or Bachelor's degree from an accredited college or university in a related field.
Knowledge of medical records, medical terminology, and disease processes required.
Strong clinical assessment and critical thinking skills required.
Excellent written and verbal communication skills required.

Nice To Haves

1 year experience with UM
Knowledge of InterQual or MCG

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 quality monitoring activities.
Maintains current knowledge base related to review processes and clinical practices.
Functions as providers' liaison for customer service issues and problem resolution.
Performs all applicable review types as workload indicates.
Fosters positive and professional relationships with internal and external customers.
Attends training and scheduled meetings for current/updated information.
Cross trains to provide 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.
The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.