Clinical Reviewer

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Clinical Reviewer (LPN, LVN, RN) to join our growing team.

Job Summary:

The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness.

***This is a remote position. The selected candidate will typically work Monday-Friday from 8:00 AM - 5:00 PM Eastern AND from 10:00 AM - 7:00 PM Eastern one day, every other week, as assigned.***

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, 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.

Required Qualifications/Experience:

• Active, unrestricted Licensed Practical Nurse (LPN) license, Licensed Vocational Nurse (LVN) license, or Registered Nurse (RN) license from the state where you reside, per contract/state requirements.
• Associate's degree or practical/vocational nursing diploma or nursing certificate program, in accordance with state requirements.
• Medical record abstracting skills, including knowledge of medical record organization, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.
• Will typically work Monday-Friday from 8:00 AM - 5:00 PM Eastern AND from 10:00 AM - 7:00 PM Eastern one day, every other week, as assigned.

Preferred Qualifications/Experience:

• Bachelor's Degree from an accredited college or university in a related field.
• 1+ years Utilization Management/Utilization Review.
• 1+ years Private Duty Nursing OR Home Health experience.
• Excellent written and verbal communication skills.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

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

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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.