Remote RN Clinical Review Advisor

Acentra; Tennessee; Remote; USD 92,000 - 105,000; Full time

Job summary

Acentra Health is seeking a Clinical Review Advisor to review medical records, prepare cases for physician review, and ensure compliance with State Medicaid policies. The role is remote within the U.S.

with standard M-F hours; the first day requires travel to the Nashville, TN office. Qualified candidates will have an active RN license, a Bachelor's degree, 2+ years of nursing or medical records experience, and a dedicated home office with reliable internet.

Qualifications

• Active, unrestricted RN license from the state where you reside or compact multi-state.
• Bachelor's degree in nursing or related field in accordance with state requirements.
• 2+ years of recent nursing or medical records experience.
• Must have a dedicated home office and reliable internet access to allow for secure viewing of protected health information.

Responsibilities

• Prepare medically necessity reviews within established timeframes and contractual guidelines, including formatting, documentation of appealed services, and citation of applicable Medicaid rules.
• Communicate with external customers to provide information relevant to the review process and results.
• Review requests for inconsistencies or missing information and coordinate returns and clarifications with staff and Tennessee Medicaid departments.

Skills

RN license

Home office setup

Strong communication

Education

Bachelor's degree in nursing or related field

Tools

Microsoft Office

Job description

Acentra Health is seeking a Clinical Review Advisor to review medical records, prepare cases for physician review, and ensure compliance with State Medicaid policies. The role is remote within the U.S.

with standard M-F hours; the first day requires travel to the Nashville, TN office. Qualified candidates will have an active RN license, a Bachelor's degree, 2+ years of nursing or medical records experience, and a dedicated home office with reliable internet.