Remote RN Clinical Review Advisor - Medicaid

Acentra Health, LLC; United States; Remote; USD 92,000 - 105,000; Full time

Benefits offered by this job

Comprehensive health plans

Paid time off

Retirement savings

Job summary

Acentra Health, LLC is seeking a Clinical Review Advisor to join our team. The role focuses on reviewing medical records, preparing cases for physician review, and performing related duties for selected cases with attention to MCC policies.

The position is remote within the United States with standard Central Time business hours. The first day requires travel to the Nashville, TN office, and coordination with Tennessee Medicaid departments is routine.

Qualifications

• Active, unrestricted RN license from the state of residence or compact multi-state.
• Bachelor's degree in a related field as per state requirements.
• 2+ years of recent nursing or medical records experience.
• Must have a dedicated home office and reliable internet access for secure viewing of PHI.

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 with staff and Tennessee Medicaid departments.
• Monitor the Outstanding MNR Report to track deliverables and priorities.
• Coordinate MCC witnesses with the Office of Fair Hearings, including prehearing conferences and scheduling.
• Edit reviews and collaborate with Physicians to address quality issues and improvements.
• Collaborate with staff and Medical Director to implement process improvements.
• Assist Medical Director with communications to Medicaid staff regarding quality concerns.
• Support training for Reviewers and quarterly quality assurance activities.
• Adhere to corporate policies including HIPAA Privacy and Security Rules.

Skills

RN license

Home office setup

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Acentra Health, LLC is seeking a Clinical Review Advisor to join our team. The role focuses on reviewing medical records, preparing cases for physician review, and performing related duties for selected cases with attention to MCC policies.

The position is remote within the United States with standard Central Time business hours. The first day requires travel to the Nashville, TN office, and coordination with Tennessee Medicaid departments is routine.