Clinical Reviewer - SCA (Remote - RN)

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 Acentra seeks a Clinical Reviewer to join our growing team. Job Summary: The Clinical Reviewer utilizes clinical expertise during beneficiary interaction in conjunction with contract requirements, critical thinking and utilize decision-making skills to assist with communicating medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA and other regulatory standards.

• Shift Information: This position requires availability to work between 8:00 a.m. and 8:00 p.m. ET, Monday through Friday, and 11:00 a.m. to 6:00 p.m. ET on weekends and holidays.*

Job Responsibilities:

• Assures accuracy and timeliness of reputed company applicable review type cases reputed company contract requirements
• Assesses, evaluates, and addresses daily workload and call 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 reputed company knowledge reputed company reputed company to review processes and clinical practices reputed company to the review processes, functions as the initial resource to nurse reviewers regarding reputed company review process questions and/or concerns
• Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution
• Performs reputed company applicable review types as workload indicates
• Fosters positive and professional relationships and act 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 and for maintenance and use of reputed company/updated information for review
• Cross trains and reputed company duties of other reputed company to provide a flexible workforce to meet client/customer needs
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company Rules

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

Qualifications

Required Qualifications

• Active, unrestricted LPN or RN license in the applicable state and/or a Compact State license.
• Knowledge of the organization of medical records, medical terminology, and disease process required
• Strong clinical assessment and critical thinking skills required
• Medical record abstracting skills required
• 2+ years of clinical experience in a hospital or post-acute environment required.

Preferred Qualifications

• Minimum of one year UR and/or Prior Authorization or reputed company experience.
• Requires excellent written and verbal communication skills
• Must be proficient in reputed company Office and internet/web navigation
• Bachelor’s Degree from an accredited college or university in a reputed company field
• Some knowledge of Case Management, UR and/or Prior Authorization or reputed company experience is preferred
• Experience in call center environment a plus
• Experience in a behavioral health setting a plus
• Bilingual (English/Spanish) a plus

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 reputed company. Our company cares about our employees, giving you the tools and encouragement, you need to reputed company the finest work of your career. 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 interest you. Best of luck in your search! ~ The reputed company reputed company Team Visit us at https://careers.acentra.com/jobs EOE 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, gender identity, national reputed company, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, reputed company, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is below: “Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and reputed company level.” Pay Range USD $28.37 - USD $33.00 /Hr. Apply tot his job Apply To this Job