Clinical RN Reviewer – Utilization & Quality

Acentra; Florida; Hybrid; USD 39,000 - 54,000; Full time

Job summary

Acentra Health is seeking a Clinical Reviewer-RN based in Florida to review medical records against criteria and contract requirements for medical appropriateness. The role emphasizes accuracy, timeliness, and collaboration with supervisors and providers.

Requirements include a Bachelor’s Degree and an active RN license, with at least two years of clinical experience, strong clinical assessment, and excellent communication skills.

Qualifications

• Bachelor’s Degree and a minimum of 2 years of clinical experience.
• Active unrestricted RN license per contract requirements.
• Knowledge of medical records organization, 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 to meet workload demands.
• In collaboration with Supervisor, responsible for quality monitoring activities including identifying improvement areas and implementing plans.
• Maintains current knowledge base related to review processes and clinical practices; acts as initial resource to nurse reviewers.
• Functions as provider liaison and contact/resource for provider 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 to ensure effective collaboration.
• Attends training and scheduled meetings for maintenance and use of updated information.
• Cross trains and performs duties of other contracts to provide a flexible workforce.

Skills

Clinical assessment

Critical thinking

Written communication

Verbal communication

Medical records knowledge

Education

Bachelor’s Degree

RN license

Job description

Acentra Health is seeking a Clinical Reviewer-RN based in Florida to review medical records against criteria and contract requirements for medical appropriateness. The role emphasizes accuracy, timeliness, and collaboration with supervisors and providers.

Requirements include a Bachelor’s Degree and an active RN license, with at least two years of clinical experience, strong clinical assessment, and excellent communication skills.