Clinical Reviewer
Acentra Health
Job Overview
Who's the hiring manager?
Sign up to PitchMeAI to discover the hiring manager's details for this job. We will also write them an intro email for you.
Job Description
Company Overview
Acentra Health empowers better health outcomes through technology, services, and clinical expertise. Their mission is to innovate health solutions with maximum value and impact. Lead the Way is their rallying cry, inviting passionate individuals to own their work and drive impactful change.
Job Summary and Responsibilities
The Clinical Reviewer role utilizes clinical expertise to review medical records against established criteria and contract requirements. This is a remote position within the U.S. Applicants must be clinically licensed in the State of Indiana or hold a compact license.
Work Schedule
Five 8-hour shifts between 9:00 AM and 6:00 PM Eastern Time with alternating weekends and holidays.
Key Responsibilities
- Review medical records accurately and timely per contract requirements.
- Assess workload and adjust daily schedules to meet demands.
- Collaborate with supervisors on quality monitoring.
- Maintain current knowledge of review processes and clinical practices.
- Act as a liaison for provider customer service issues.
- Engage in cross training to ensure a flexible workforce.
- Adhere to HIPAA and corporate policies.
Qualifications
Required: Active, unrestricted LPN/LVN or RN license in Indiana (or compact), an Associate's degree (Bachelor's preferred) or accredited nursing diploma, 2+ years of Utilization Review/Management and medical necessity review experience, as well as familiarity with InterQual criteria and/or Milliman Care Guidelines. Strong clinical, assessment, and communication skills are essential.
Preferred: 3+ years of clinical experience, knowledge of NCQA and URAC standards, proficiency in Microsoft Office, and excellent time management.
Why Join Acentra Health?
This role offers meaningful work that improves people's lives across the country, a supportive team environment, and comprehensive benefits such as health plans, paid time off, retirement savings, corporate wellness, educational assistance, and more.
Compensation
Hourly pay ranges between USD $28.37 and USD $39.19, based on experience and skill level in line with Acentra Health's compensation philosophy.
Equal Opportunity Employer
Acentra Health is an Equal Opportunity Employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, or any other protected status.
Key skills/competency
- Clinical review
- Nursing
- Medical records
- Utilization review
- HIPAA
- InterQual
- Milliman
- Customer service
- Quality monitoring
- Time management
How to Get Hired at Acentra Health
- Research Acentra Health's culture: Study their mission and employee reviews.
- Customize your resume: Highlight UR and clinical expertise.
- Prepare for behavioral interviews: Practice scenario-based questions.
- Showcase technical skills: Emphasize multi-system proficiency.
Frequently Asked Questions
Find answers to common questions about this job opportunity
Explore similar opportunities that match your background