Regional Mentor QA Reviewer (Hybrid)
CNSI | |
paid time off | |
United States, North Carolina, Raleigh | |
224 South Dawson Street (Show on map) | |
Oct 02, 2024 | |
Description
CNSI and Kepro are now Acentra Health! 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 company's mission, actively engage in problem-solving, and take ownership of your work daily. 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 seeks a Regional Mentor QA Reviewer (RN - Hybrid) to join our growing team. Job Summary: The Regional Mentor travels to perform education and initial/re-evaluation assessments of Aged and Disabled Waiver members for the purposes of determining program medical eligibility. Provides education to applicants/members and conducts the Pre-Admission Screening assessment. Manages a caseload of assigned members to ensure that assessments are scheduled, appropriate persons are in attendance, assessments are performed and data is entered into the APS CareConnection within prescribed timelines.
The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time. Job Responsibilities: Conducts mediations at the request of beneficiaries who have had an adverse decision for all programs. Works to negotiate settlements during mediations Is knowledgeable of NC Medicaid Recipient Due Process Rights and Prior Approval Policies and Procedures in order maintain appropriate systems for implementation and compliance .
Duties related to maintenance of internal databases (Atrezzo) Supports analysis of the Mediation and Appeals process for quality improvement by maintaining information in database for tracking/trending all decisions, dates, issues and outcomes
Required Qualifications/Experience:
Preferred Qualifications/Experience:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state. 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 nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career. 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 interest you. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at Acentra.com/careers/ EOE 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, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The pay for this position is $82,000.00. "Based on our compensation philosophy, an applicant's placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." |