Clinical Reviewer-RN

Acentra Health, LLC; United States; On-site; USD 39,000 - 54,000; Full time

Benefits offered by this job

Health plans

Paid time off

Retirement savings

Job summary

Acentra Health, LLC is seeking a Clinical Reviewer-RN to review medical records for medical appropriateness in accordance with contract requirements. The role emphasizes accuracy, timeliness, and adherence to review procedures across multiple contract types.

You will collaborate with supervisors, maintain up-to-date knowledge of review processes, and serve as a resource to nurse reviewers while interacting with providers to resolve issues and ensure quality outcomes.

Qualifications

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

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 workload demands.
• In collaboration with Supervisor, responsible for quality monitoring activities and improvement plans.
• Maintains knowledge base related to review processes and clinical practices; serves as resource for nurse reviewers.
• Functions as providers’ liaison for customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Fosters positive relationships and acts as liaison with internal and external customers.
• Attends training and meetings for maintenance of updated information.
• Cross trains to provide flexible workforce to meet client needs.

Skills

Clinical assessment

Critical thinking

Written and verbal communication

Medical records knowledge

Provider liaison

Time management

Education

Bachelor’s Degree

RN license (State/Compact)

Tools

InterQual Criteria

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.

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.

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

• 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.

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!

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 https://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 $39.19 /Hr.