Clinical Reviewer-PRN (RN) (Remote)

Acentra; Northern (KY); Hybrid; USD 39,000 - 52,000; Full time

Benefits offered by this job

401(k) plan with company match

Wellness programs

Employee discount programs

Employee Assistance Program (EAP)

Job summary

Acentra Health in the United States seeks a Clinical Reviewer to join our remote team. The role uses clinical expertise to review medical records against contract criteria and CMS guidelines.

You will work on-call weekends, holidays and evenings, with cross-functional collaboration and adherence to HIPAA. This position emphasizes accuracy, timely processing, and maintaining up-to-date knowledge of review processes.

Qualifications

• Active, unrestricted RN license in any state.
• Minimum 2+ years of experience with CMS case processing.
• Knowledge of medical records and medical terminology.
• Skilled in reviewing, interpreting, and abstracting data from medical records.
• Strong clinical assessment and critical thinking skills.
• Excellent verbal and written communication skills.
• Proficient in Microsoft Office and internet/web navigation.

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.

Job description

Company Overview

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.

At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles.

Job Summary and Responsibilities

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

Job Summary:

• 
  

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

  
  

  Position is remote

  
  

  Required Work Hours: On-call weekends, holidays and evenings

  
  

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.

Qualifications

Required Qualifications

• Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state License.


• A minimum of 2+ years of experience with federal CMS case processing.


• Knowledge of medical records and medical terminology.


• Skilled in reviewing, interpreting, and abstracting data from medical records.


• Strong clinical assessment and critical thinking skills.


• Excellent verbal and written communication skills.


• Must be proficient in Microsoft Office and internet/web navigation.

Preferred Qualifications

• Knowledge of IRO Accreditation (URAC) standards.


• Knowledge of Independent Review Organization (IRO).


• Knowledge of Medicare (CMS) guidelines.


• Experience with Medical Appeals.


• Ability to work in a team environment.


• Flexibility and strong organizational 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.This position includes access to select Acentra Health benefits and programs, such as participation in the Acentra Health 401(k) Plan with company match, access to wellness and employee discount programs, and Employee Assistance Program (EAP) resources.

Thank You!

We know your time is valuable and we thank you for applying for this position. Best of luck in your search!

We are committed to providing a secure and positive hiring experience. Depending on the role, interviews may be conducted virtually, in person, or through a combination of both. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process.

~ The Acentra Health Talent Acquisition Team

Visit us at http://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.

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.”

Pay Range

USD $28.37 - USD $38.00 /Hr.