Clinical Reviewer-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 mission, actively engage in problem-solving, and take ownership of your work every day.

About the role

The Clinical Reviewer-RN reviews medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness.

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 the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
• Maintains current knowledge base related to review processes and clinical practices related to the review processes; functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
• Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Fosters positive and professional relationships and acts as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Attends training and scheduled meetings for maintenance and use of current/updated information for review.
• Cross-trains and performs duties of other contracts to provide a flexible workforce to meet client/customer needs.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Requirements

• Active unrestricted RN license in the applicable State and/or Compact State per contract requirements.
• Minimum of 2 years of clinical experience.
• Bachelor’s Degree (or equivalent experience: 6 years of directly relevant professional experience in lieu of a Bachelor’s degree, or 3 years with an Associate’s degree).

Qualifications

• Knowledge of the organization of medical records, medical terminology, and disease process.
• Strong clinical assessment and critical thinking skills.
• Medical record abstracting skills.
• 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

USD $28.37 - USD $39.19 /Hr. An applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.