Clinical Reviewer – Utilization & Quality

Acentra

Northern (KY)

Hybrid

USD 39,000 - 48,000

Full time

6 days ago

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Job summary

Acentra Health is seeking a Clinical Reviewer to review medical records against contract requirements using clinical expertise. The role focuses on ensuring accuracy and timeliness of review cases within defined contracts.

The ideal candidate will hold an active unrestricted LPN or RN license with 1+ year experience in Utilization Review, strong clinical knowledge, and proficient communication. Join a team dedicated to improving health outcomes and staying compliant with HIPAA rules.

Qualifications

Active unrestricted LPN/RN license.
1+ years' experience of Utilization Review.
Knowledge of medical records, medical terminology, and disease processes.
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 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.