Clinical Reviewer (LPN, LVN, RN)
About the position Acentra Health is looking for a Clinical Reviewer (LPN, LVN, RN) to join their growing team. The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness. The selected candidate will typically work Monday-Friday from 8:00 AM – 5:00 PM Eastern AND from 10:00 AM - 7:00 PM Eastern one day, every other week, as assigned.
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, including identifying areas of improvement and plan implementation of improvement areas.
- Maintains current knowledgebase related to review processes and clinical practices related to the review processes, functions as the internal resource to nurse reviewers regarding all review process questions and/or concerns.
- Functions as provider 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 liaises with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
- Attends training and scheduled meetings for maintenance and use of current/updated information for review.
- Cross-trains and performs 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.
Requirements
- Active, unrestricted Licensed Practical Nurse (LPN) license, Licensed Vocational Nurse (LVN) license, or Registered Nurse (RN) license from the state where you reside, per contract/state requirements
- Associate's degree or practical/vocational nursing diploma or nursing certificate program, in accordance with state requirements
- 1+ years Utilization Management/Utilization Review
- Medical record abstracting skills, including knowledge of medical record organization, medical terminology, and disease processes
- Strong clinical assessment and critical thinking skills
Nice-to-haves
- Bachelor's Degree from an accredited college or university in a related field
- 1+ years Private Duty Nursing OR Home Health experience
- Excellent written and verbal communication skills
Benefits
- comprehensive health plans
- paid time off
- retirement savings
- corporate wellness
- educational assistance
- corporate discounts
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