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Acentra Health · 1 day ago

Clinical Reviewer - SCA (Remote - RN)

United States

Full-time

Remote

Entry, Mid Level

$28.37/hr - $33/hr

2+ years exp

Acentra Health is dedicated to empowering better health outcomes through technology and clinical expertise. The Clinical Reviewer will utilize clinical expertise to communicate medical appropriateness during beneficiary interactions while ensuring compliance with regulatory standards and maintaining production goals.

Health Care

Responsibilities

Assures accuracy and timeliness of all applicable review type cases within 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 current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns

Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution

Performs all 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 current/updated information for review

Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs

Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Qualification

Active RN licenseClinical assessment skillsMedical record abstracting2+ years clinical experienceMicrosoft Office proficiencyMedical terminologyDisease processBilingual (English/Spanish)Communication skills