Acentra Health, LLC
The Clinical Reviewer reviews medical records against specific criteria to determine medical appropriateness and ensures accuracy and timeliness of cases. They also act as a provider liaison and maintain current knowledge of clinical practices to support internal nurse reviewers.
Candidates must hold an active, unrestricted LPN, LVN, or RN license and an associate's degree or nursing diploma. Preferred qualifications include a bachelor's degree and experience in utilization management or home health nursing.
Job Summary and Responsibilities
Acentra Health is looking for a Clinical Reviewer (LPN, LVN, RN) to join our growing team.
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, including identifying areas of improvement and plan implementation of improvement areas. Maintains current knowledgebase related to review processes and clinical practices related to the review processes, functions as the internal resource to nurse reviewers regarding all review process questions and/or concerns. Functions as provider liaison and contact/resource person for provider customer service issues and problem resolution. Performs all applicable review types as workload indicates. Fosters positive and professional relationships and liaises with internal and external customers to ensure effective working relationships and team building to facilitate the review process. Attends training and scheduled meetings for maintenance and use of current/updated information for review. Cross-trains and performs duties of other contracts to provide a 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 duties that management may deem necessary.
Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Experience in Lieu of Degree For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree. Compensation The pay range for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.” Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.
Usd $28.37 - Usd $35.00 /Hr.
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