Clinical Reviewer

Acentra Health; Virginia, McLean (MN, VA); Remote; USD 60,000 - 90,000; Full time

Job summary

An innovative healthcare company is seeking a Clinical Reviewer to leverage clinical expertise in reviewing medical records. This remote position offers a unique opportunity to contribute to better health outcomes while working with a dedicated team. You'll engage in problem-solving, ensure accuracy in reviews, and maintain quality monitoring activities. If you're passionate about making a difference in healthcare and possess strong clinical assessment skills, this role is perfect for you. Join a team that values your contributions and offers the tools you need to excel in your career.

Benefits

Comprehensive Health Plans

Paid Time Off

Retirement Savings

Corporate Wellness

Educational Assistance

Corporate Discounts

Qualifications

• Active LPN or RN license required for this role.
• 1+ years experience in Utilization Management is essential.

Responsibilities

• Review medical records against criteria and contract requirements.
• Maintain knowledge of review processes and clinical practices.

Skills

Clinical Assessment

Critical Thinking

Medical Record Abstracting

Communication Skills

Education

LPN or RN License

Utilization Management Experience

Job description

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.

Job Summary and Responsibilities

Acentra Health is looking for a Clinical Reviewer to join our growing team.

This position is remote

Job Summary:

The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.

Responsibilities:

1. Assures accuracy and timeliness of all applicable review type cases within contract requirements.
2. Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
3. In collaboration with Supervisor, responsible for quality monitoring activities.
4. Maintains current knowledge base related to review processes and clinical practices.
5. Functions as providers' liaison for customer service issues and problem resolution.
6. Performs all applicable review types as workload indicates.
7. Fosters positive and professional relationships with internal and external customers.
8. Attends training and scheduled meetings for current/updated information.
9. Cross trains to provide flexible workforce to meet client/customer needs.
10. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

Required Qualifications:

• Active unrestricted LPN or RN license from the state where you reside, per contract requirements.
• 1+ years prior Utilization Management experience.
• Knowledge of the organization of medical records, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.
• Medical record abstracting skills.
• Excellent written and verbal communication skills.

Preferred Qualifications:

• 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.
• Knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG).

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.

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 Acentra.com/careers/

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, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.