Clinical Reviewer-immediate Advocacy Discharge Assistance, RN (remote)
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 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 is looking for a Clinical Reviewer to join our growing team.** • *Job Summary:** The Clinical Reviewer will utilize clinical expertise to review medical records in accordance with contract requirements and appropriate criteria. This role requires critical thinking and decision-making skills to determine the medical appropriateness of services. The Clinical Reviewer plays a pivotal role in ensuring compliance with state government healthcare systems, contributing to quality healthcare outcomes through accurate and timely reviews. • *Job Responsibilities:** • Assure the accuracy and timeliness of all applicable case reviews in line with contract requirements • Evaluate daily workload and adjust schedules as necessary to meet departmental needs • Collaborate with the Supervisor on quality monitoring activities, identify areas of improvement, and implement action plans • Maintain current knowledge of review processes and clinical practices, serving as a resource for nurse reviewers regarding review process concerns • Act as a liaison for providers, handling customer service issues and resolving problems • Perform a variety of review types as workload demands • Build positive relationships with internal and external customers to support the review process • Participate in training and scheduled meetings to stay updated on review processes • Cross-train to support other contracts, ensuring flexibility in meeting client/customer needs Apply tot his job