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Acentra Health · 20 hours ago

Clinical Reviewer

United States

Full-time

Remote

Entry, Mid Level

$28/hr - $39/hr

1+ years exp

Acentra Health is dedicated to empowering better health outcomes through innovative solutions and clinical expertise. They are seeking a Clinical Reviewer to utilize clinical expertise in reviewing medical records against established criteria while ensuring accuracy and timeliness within contract requirements.

Health Care

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

Functions as providers' liaison for customer service issues and problem resolution

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

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

Qualification

Active LPNRN licenseClinical assessment skillsMedical records knowledgeInterQual knowledgeUtilization Review experienceCritical thinking skillsWritten communication skillsVerbal communication skills