Clinical Reviewer-Immediate Advocacy Discharge Assistance, RN

CNSI and Kepro are now Acentra Health! 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 outcomesmaking 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 is looking for a Clinical Reviewerto join our growing team.

The Clinical Reviewer will utilize clinical expertise to review medical records in accordance with contract requirements and appropriate criteria. This role requires critical thinking and decision-making skills to determine the medical appropriateness of services. The Clinical Reviewer plays a pivotal role in ensuring compliance with state government healthcare systems, contributing to quality healthcare outcomes through accurate and timely reviews.

Job Responsibilities:

• Assure the accuracy and timeliness of all applicable case reviews in line with contract requirements

• Evaluate daily workload and adjust schedules as necessary to meet departmental needs

• Collaborate with the Supervisor on quality monitoring activities, identify areas of improvement, and implement action plans

• Maintain current knowledge of review processes and clinical practices, serving as a resource for nurse reviewers regarding review process concerns

• Act as a liaison for providers, handling customer service issues and resolving problems
• Perform a variety of review types as workload demands
• Build positive relationships with internal and external customers to support the review process
• Participate in training and scheduled meetings to stay updated on review processes
• Cross-train to support other contracts, ensuring flexibility in meeting client/customer needs

Requirements

• Active, unrestricted LPN, RN, Social Worker, or other applicable clinical licenses
• Bachelor's degree from an accredited institution in a related field
• Strong clinical assessment and critical thinking skills
• Proficiency in medical record organization, medical terminology, and understanding disease processes
• Excellent written and verbal communication skills
• Experience in medical record abstracting

Preferred Qualifications/Experience:

• Active, unrestricted LPN/RN license strongly preferred
• Familiarity with contract-based healthcare services
• Knowledge of state and federal healthcare regulations

Benefits

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 22.56 to 33.00 per hour

"Based on our compensation program, 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 Acentra.com/careers/

EOE 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, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.