RN Clinical Reviewer – Utilization & Medical Records

Acentra; Richmond (VA); On-site; USD 39,000 - 54,000; Full time

Benefits offered by this job

Comprehensive health plans

Paid time off

Retirement savings

Educational assistance

Corporate discounts

Wellness programs

Job summary

Acentra Health is seeking a Clinical Reviewer to join our growing team. The role utilizes clinical expertise to review medical records against contract criteria in conjunction with contractual requirements and to assure accuracy and timeliness of review type cases.

As part of a collaborative team, you will monitor daily workloads, support quality monitoring activities, maintain current knowledge of review processes, and serve as a liaison for provider and client questions.

Qualifications

• Active unrestricted RN or Behavioral Health license in the Commonwealth of Virginia.
• Associate's degree from an accredited college or university in a related field.
• 1+ years' experience with Utilization Management.
• Knowledge of medical terminology and disease processes preferred.
• Strong clinical assessment and critical thinking 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 HIPAA rules.

Skills

Utilization Management

Clinical assessment

Written and verbal communication

Education

RN license in Virginia

Associate's degree

Job description

Acentra Health is seeking a Clinical Reviewer to join our growing team. The role utilizes clinical expertise to review medical records against contract criteria in conjunction with contractual requirements and to assure accuracy and timeliness of review type cases.

As part of a collaborative team, you will monitor daily workloads, support quality monitoring activities, maintain current knowledge of review processes, and serve as a liaison for provider and client questions.