Remote RN Clinical Review Specialist

Acentra Health; McLean (VA); Remote; USD 92,000 - 105,000; Full time

Benefits offered by this job

Comprehensive health plans

Paid time off

Retirement savings plan

Job summary

Acentra Health is seeking a Clinical Review Advisor to join our remote US team. You will review medical records, prepare cases for physician review, and ensure timely, accurate medical necessity determinations per MCC policies.

Requirements include an active RN license, a related Bachelor's degree, and 2+ years of nursing or medical records experience. A dedicated home office and reliable internet are required.

Qualifications

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

Responsibilities

• Review medical records and prepare cases for physician review.
• Prepare reports for medical necessity reviews following MCC policies.
• Communicate with external customers regarding review results.
• Monitor the MNR report and prioritize workload accordingly.
• Coordinate MCC witnesses with the Office of Fair Hearings.
• Edit reviews and collaborate with Physicians to address quality issues.
• Assist with process improvements and QA activities.
• Adhere to HIPAA and corporate policies.

Skills

Excellent communication

Attention to detail

Time management

Education

Bachelor's degree in related field

Tools

Microsoft Office

Job description

Acentra Health is seeking a Clinical Review Advisor to join our remote US team. You will review medical records, prepare cases for physician review, and ensure timely, accurate medical necessity determinations per MCC policies.

Requirements include an active RN license, a related Bachelor's degree, and 2+ years of nursing or medical records experience. A dedicated home office and reliable internet are required.