Clinical Review Specialist

Acentra Health; United States; Sur place; USD 39 000 - 54 000; Plein temps

Résumé du poste

Acentra Health is seeking a qualified nurse reviewer to utilize clinical expertise in reviewing medical records against contract requirements. You will ensure accuracy, manage daily workloads, and support quality monitoring in collaboration with leadership.

The role requires active LPN or RN licensure, knowledge of medical terminology, and excellent communication skills to serve providers and clients across the country.

Qualifications

• Active unrestricted LPN or RN license.
• For LPN: associate degree or practical nursing diploma/certificate.
• For RN: associate degree or bachelor’s degree in a related field.
• Knowledge of medical records, medical terminology, and disease processes.

Responsabilités

• 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 HIPAA and its Privacy and Security Rules.

Connaissances

Clinical assessment

Medical terminology

Communication skills

Formation

LPN licensure or diploma

RN licensure or degree

Description du poste

Acentra Health is seeking a qualified nurse reviewer to utilize clinical expertise in reviewing medical records against contract requirements. You will ensure accuracy, manage daily workloads, and support quality monitoring in collaboration with leadership.

The role requires active LPN or RN licensure, knowledge of medical terminology, and excellent communication skills to serve providers and clients across the country.