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Acentra Health · 4 days ago

Clinical Reviewer RN - PRN

United States

Part-time

Remote

Entry, Mid Level

$28.37/hr - $40/hr

2+ years exp

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. They are looking for a Clinical Reviewer RN-PRN to utilize clinical expertise for the review of medical records and determine medical appropriateness while maintaining production goals and quality standards.

Health Care

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

Qualification

Active RN licenseClinical experienceMedical records knowledgeCritical thinking skillsCommunication skillsHIPAA knowledgeDurable medical equipment knowledgeTeam playerSelf-motivated