Clinical Reviewer (Remote - SCA)
Job Overview Acentra Health is looking for a Clinical Reviewer (SCA) to join our growing team. The purpose of this position is to utilize clinical expertise during beneficiary interaction and determine appropriateness for advocacy intervention in conjunction with contract requirements, critical thinking, and decision-making to assist with communicating medical appropriateness while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA and other regulatory standards. 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. It is an invitation to engage in problem-solving and take ownership of your work every day. Acentra Health offers opportunities to accelerate your career and contribute to health solutions in the public sector.
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 department demands
- In collaboration with Supervisor, responsible for quality monitoring activities including identifying areas for improvement and implementing plans
- Maintains current knowledge base related to review processes and clinical practices; acts as the initial resource to nurse reviewers regarding review process questions
- Functions as providers’ liaison and contact/resource for provider customer service issues and problem resolution
- Performs all applicable review types as workload indicates
- Fosters positive professional relationships with internal and external customers to facilitate the review process
- Attends training and scheduled meetings for maintenance and use of current information for review
- Cross-trains and performs duties of other contracts to provide a flexible workforce to meet client needs
- Reads, understands, and adheres to all corporate policies including HIPAA Privacy and Security Rules
Note The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties as needed.
Qualifications
Required Qualifications
- Active unrestricted LPN, RN, Social Worker, or other applicable State and/or Compact State clinical license
- Minimum three years of clinical experience in an acute or med-surgical environment
- Strong clinical assessment and critical thinking skills
- Medical record abstracting skills
- Excellent written and verbal communication skills
- Proficiency in Microsoft Office and Internet/web navigation
Preferred Qualifications
- Bachelor’s Degree in a related field
- Some knowledge of Case Management, UR and/or Prior Authorization or related experience
- Experience in a behavioral health setting
- Bi-lingual abilities
Compensation and Benefits
Base pay range $28.00/hr - $33.00/hr Benefits are a key component of your rewards package, including comprehensive health plans, paid time off, retirement savings, wellness programs, educational assistance, corporate discounts, and more. Equal Opportunity 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 law. Notes This posting includes compensation information. The pay range provided is USD $28.00 - $33.00 per hour and varies based on experience and qualifications. Applications are reviewed on a rolling basis. #J-18808-Ljbffr Experience: 3 years required