Clinical Reviewer-RN

Acentra Health, LLC; Oregon; Hybrid; USD 39,000 - 54,000; Full time

Benefits offered by this job

Health coverage

Paid time off

Retirement savings

Wellness program

Educational assistance

Job summary

Acentra Health is seeking a Clinical Reviewer-RN to join our growing team. The role focuses on reviewing medical records against contract criteria to determine medical appropriateness and ensure timely, accurate review outcomes.

Responsibilities include workload management, quality monitoring, and serving as a liaison for providers and clients. A Bachelor’s degree with an RN license and strong communication skills are required.

Qualifications

• Bachelor’s degree plus minimum 2 years of clinical experience.
• Active unrestricted RN license in applicable state/compact state.
• Knowledge of medical records organization and terminology.

Responsibilities

• Review medical records against criteria per contract requirements.
• Monitor workload and adjust schedules to meet demands.
• Support quality monitoring and implement improvement plans.
• Serve as liaison for provider services and client questions.
• Perform various review types as workload requires.
• Maintain up-to-date knowledge of review processes and clinical practices.

Skills

Clinical assessment

Critical thinking

Communication skills

Time management

Team collaboration

Education

Bachelor’s Degree

RN license

Tools

InterQual Criteria

Medical record abstracting

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-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.

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 the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
• Functions as providers’ 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 act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Attends training and scheduled meetings and for maintenance and use of current/updated information for review.
• Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs.
• 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

• Bachelor’s Degree and a minimum of 2 years of clinical experience.
• Active unrestricted RN in the applicable State and/or Compact State clinical license per contract requirements.
• Knowledge of the organization of medical records, medical terminology, and disease process.
• Strong clinical assessment and critical thinking skills.
• Excellent written and verbal communication skills.

Preferred Qualifications

• Utilization Management (UM) experience.
• Experience utilizing InterQual Criteria.
• Medical record abstracting 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

BenefitsBenefits 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.”

Pay Range

USD $28.37 - USD $39.19 /Hr.

EEO Statement

EEO AA M/F/Vet/DisabilityAcentra 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.