Clinical Reviewer - RN (Personal Care) - PRN (Remote in Arkansas)

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.

Acentra Health is looking for a Clinical Reviewer - RN (Personal Care) - PRN (Remote within Arkansas) 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.
• Completes prior authorization, for Personal Care services.
• Collaborates with the Clinical Director and Team Supervisor to:
  • Define, review and document findings
  • Monitor provider trends
  • Recommend internal policies, procedures, and processes
• Collaborates with Team Supervisor and Medical Director to determine Medical Necessity of services.
• Serves as a resource for Personal Care providers.
• Assists Provider Relations Specialist with program-specific education and training.
• Maintains client privacy, confidentiality, and safety at all times.
• Ensures adherence to ethical, legal, and accreditation/regulatory standards.

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.
• 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.
• Conducts initial and prior authorization for Personal Care services.
• Evaluates the quality and compliance of service documentation in client records, ensuring adherence to Arkansas Medicaid regulations.
• Refers cases to the Physician Reviewer for medical necessity determinations when appropriate.
• Serves as a liaison between the organization throughout the review process.
• Provides education on the Reconsideration and Appeal process.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

** This is a fully remote position where you must reside and work in the state of Arkansas. **

** The hours for this PRN role, as well as turnaround time, would be discussed during the interview process. **

** There is no required Travel for this role. **

Required Qualifications/Experience:

• Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license.
• Associate's, Bachelor's degree (or Diploma) in Nursing.
• 2+ years of clinical experience in an acute OR home health environment.
• 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization.
• 1+ years of knowledge of medical records, medical terminology, and disease process organization.

Preferred Qualifications/Experience:

• Knowledge of Medicaid guidelines.
• Medical Record Abstracting skills.
• Clinical assessment and critical thinking skills.
• Excellent verbal and written communication skills.
• Ability to work in a team environment.
• Flexibility and strong organizational skills.
• Proficient in Microsoft Office and Internet/Web Navigation.
• Experience working in a Remote environment.

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Why us?

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.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

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.