Clinical Reviewer - (LPN, LVN, or RN)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. We invite you to embrace our rallying cry, "Lead the Way," by actively engaging in problem-solving and taking ownership of your work every day.

About the Role

The Clinical Reviewer (LPN, LVN, or RN) utilizes clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.

Schedule: Typically Monday–Friday, 8:00 AM–5:00 PM Eastern, with one day every other week from 10:00 AM–7:00 PM Eastern, as assigned.

Responsibilities

• Assure accuracy and timeliness of all applicable review-type cases within contract requirements.
• Assess, evaluate, and address daily workload and queues; adjust work schedules daily to meet department demands.
• Collaborate with Supervisor on quality monitoring activities.
• Maintain current knowledge base related to review processes and clinical practices.
• Function as providers’ liaison for customer service issues and problem resolution.
• Perform all applicable review types as workload indicates.
• Foster positive and professional relationships with internal and external customers.
• Attend training and scheduled meetings for current/updated information.
• Cross-train to provide a flexible workforce to meet client/customer needs.
• Read, understand, and adhere to all corporate policies, including HIPAA and its Privacy and Security Rules.

Requirements

• Active, unrestricted Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), or Registered Nurse (RN) license from the state where you reside.
• Medical record abstracting skills, including knowledge of medical record organization, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.

Qualifications

Preferred Qualifications:

• 1+ years of Private Duty Nursing or Home Health experience.
• 1+ years of Utilization Management/Utilization Review experience.
• Excellent written and verbal communication skills.

Benefits

Our benefits are designed to provide additional protection, security, and support for both your career and your life away from work. They include:

• Comprehensive health plans.
• Paid time off.
• Retirement savings.
• Corporate wellness programs.
• Educational assistance.
• Corporate discounts.

Pay

Pay Range: USD $28.37 – USD $35.00 per hour. Placement within this range depends on years of applicable experience and skill level.