Clinical Reviewer (LVN, LPN, or RN)

Job Description
Company Overview

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. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. 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.

Job Summary and Responsibilities

Acentra Health is looking for a Clinical Reviewer (LVN/LPN/RN) to join our growing team.

Job Summary:

The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.

Schedule: This is a second shift position with schedule options of either 12:00 PM to 8:30 PM Eastern with every other Saturday, or 10:00 AM to 8:30 PM Eastern with rotating weekend coverage. The department operates seven days a week, so some holiday coverage is required. Major holidays are rotated, schedules are provided in advance, and shift trades may be available.

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.

Qualifications

Required Qualifications

Active, unrestricted Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license from the state where you reside
Associate's degree or practical/vocational nursing diploma or practical/vocational nursing certificate program, in accordance with state requirements
2+ years of experience in long term care, skilled nursing facilities, or acute inpatient care

Preferred Qualifications

Knowledge of medical records, medical terminology, and disease processes
Strong clinical assessment and critical thinking skills
Excellent written and verbal communication skills