Clinical Reviewer-RN

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles. Acentra Health is looking for a Clinical Reviewer-RN to join our growing team. The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness. Assures accuracy and timeliness of all applicable review type cases within contract requirements. 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. 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. Bachelor’s Degree and a minimum of 2 years of clinical experience. Active unrestricted RN in the applicable State and/or Compact State clinical license per contract requirements. Knowledge of the organization of medical records, medical terminology, and disease process. Medical record abstracting skills. We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process. ~ The Acentra Health Talent Acquisition Team EEO AA M/F/Vet/Disability Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.