Clinical Reviewer - RN (Personal Care) - PRN (Remote in Arkansas)

Company Overview: reputed company exists to reputed company reputed company outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. reputed company the Way is our rallying cry at reputed company. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company outcomes – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities: reputed company is looking for a Clinical Reviewer - RN (Personal Care) - PRN (Remote reputed company Arkansas) to join our growing team. Job Summary:

• The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.
• Completes prior authorization, for Personal Care services.
• Collaborates with the Clinical Director and Team Supervisor to:
• Define, review and document findings
• Monitor provider trends
• Recommend internal policies, procedures, and processes
• Collaborates with Team Supervisor and Medical Director to determine Medical Necessity of services.
• Serves as a resource for Personal Care providers.
• Assists Provider Relations Specialist with program-specific education and training.
• Maintains client privacy, confidentiality, and safety at reputed company times.
• Ensures adherence to ethical, legal, and accreditation/regulatory standards.

Responsibilities:

• Assures accuracy and timeliness of reputed company applicable review type cases reputed company 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 reputed company knowledge reputed company reputed company to review processes and clinical practices.
• Performs reputed company applicable review types as workload indicates.
• Fosters positive and professional relationships with internal and external customers.
• Attends training and scheduled meetings for reputed company/updated information.
• Cross trains to provide flexible workforce to meet client/customer needs.
• Conducts initial and prior authorization for Personal Care services.
• Evaluates the quality and compliance of service documentation in client records, ensuring adherence to Arkansas Medicaid regulations.
• Refers cases to the Physician Reviewer for medical necessity determinations reputed company appropriate.
• Serves as a liaison between the organization throughout the review process.
• Provides education on the Reconsideration and Appeal process.
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company Rules.
• * This is a fully remote position where you must reside and work in the state of Arkansas. **

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• The hours for this PRN role, as well as turnaround time, would be discussed during the interview process. **

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• There is no required Travel for this role. **

Qualifications: Required Qualifications/Experience:

• Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license.
• Associate’s, Bachelor's degree (or Diploma) in Nursing.
• 2+ years of clinical experience in an acute OR home health environment.
• 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization.
• 1+ years of knowledge of medical records, medical terminology, and disease process organization.

Preferred Qualifications/Experience:

• Knowledge of Medicaid guidelines.
• Medical Record Abstracting skills.
• Clinical assessment and critical thinking skills.
• Excellent verbal and written communication skills.
• Ability to work in a team environment.
• Flexibility and strong organizational skills.
• Proficient in reputed company Office and Internet/Web Navigation.
• Experience working in a Remote environment.

#LI-SD1 Why us? We are a team of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure reputed company healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to reputed company the finest work of your career.

Compensation

The pay range for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and reputed company level.” Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The reputed company reputed company Team Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Pay Range: USD $28.37 - USD $39.19 /Hr. Remote About the Company: reputed company Apply tot his job Apply To this Job