Clinical Reviewer RN - PRN

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.

Lead the Way is our rallying cry at Acentra Health. 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. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Clinical Reviewer RN-PRN to join our growing team.

Job Summary:

Utilize clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision-making skills to determine medical appropriateness, while maintaining production goals and quality standards.

***This is a remote position, but candidates must reside in Alabama and hold an active Alabama license***

Job Responsibilities:

• Review and interpret patient records and compare against criteria to determine medical necessity and appropriateness of care.
• Determine if the medical record documentation supports the need for services.
• Determine approval or initiate a referral to the consulting physician and process the physician's decision.
• Abstract review-related data/information accurately and timely.
• Foster positive and professional relationships and act as a liaison with internal and external customers to ensure effective working relationships and team building.
• Attend trainings, and scheduled meetings.
• Maintain medical records confidentiality at all times through proper use of computer, passwords, maintenance of secured files, and adherence to HIPAA policies.
• Actively cross-train to perform duties within the Alabama contract as well as for other contracts within the Acentra network to provide a flexible workforce to meet client/consumer needs.
• Assist in the Provider and Recipient phone queues when the need arises.
• Must be self-motivated, a team player and energetic about meeting personal and professional goals.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

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.

Required Qualifications/Experience:

• Active, unrestricted RN license.
• Must reside in the state of Alabama and must be in good standing with Alabama Board of Nursing.

• Minimum 2 years of clinical experience in an acute care setting or med-surg environment.

• Knowledge of medical records, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.
• Excellent written and verbal communication skills.

Preferred Qualifications/Experience:

• Multi-State license.
• Experience/knowledge with durable medical equipment prior authorization requirements.

Why us?

We are a team of experienced 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 better 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 achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your 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 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 skill 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 Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.