Note: The job is a remote job and is open to candidates in USA. Acentra Health is dedicated to empowering better health outcomes through technology and clinical expertise. They are seeking a Clinical Reviewer - RN (Personal Care) to utilize clinical expertise in reviewing medical records against criteria and collaborating with team members to ensure compliance and quality in personal care services.
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.
• 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.
• 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 when 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 all corporate policies including policies related to HIPAA and its Privacy and Security Rules.
Skills
• 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.
• 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 Microsoft Office and Internet/Web Navigation.
• Experience working in a Remote environment.
Company Overview
• Acentra Health is a provider of clinical services and technological solutions to government healthcare organizations. It was founded in 1994, and is headquartered in Mclean, Virginia, USA, with a workforce of 1001-5000 employees. Its website is https://acentra.com/.
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