RN Telehealth Full-time
Acentra Health

Clinical Reviewer-PRN (RN) (Remote)

$28.37 - $38 / hour
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.

 

At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles.

Job Summary and Responsibilities:

Acentra Health is looking for a Clinical Reviewer 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.

     

    ***Position is remote***

     

    ** Required Work Hours: On-call weekends, holidays and evenings**


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.
  • 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.
Qualifications:

Required Qualifications

  • Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state License.
  • A minimum of 2+ years of experience with federal CMS case processing.
  • Knowledge of medical records and medical terminology.
  • Skilled in reviewing, interpreting, and abstracting data from medical records.
  • Strong clinical assessment and critical thinking skills.
  • Excellent verbal and written communication skills.
  • Must be proficient in Microsoft Office and internet/web navigation.

Preferred Qualifications

  • Knowledge of IRO Accreditation (URAC) standards.
  • Knowledge of Independent Review Organization (IRO).
  • Knowledge of Medicare (CMS) guidelines.
  • Experience with Medical Appeals.
  • Ability to work in a team environment.
  • Flexibility and strong organizational skills.

 

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.

 

Benefits

 

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. This position includes access to select Acentra Health benefits and programs, such as participation in the Acentra Health 401(k) Plan with company match, access to wellness and employee discount programs, and Employee Assistance Program (EAP) resources.

 

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!

 

We are committed to providing a secure and positive hiring experience. Depending on the role, interviews may be conducted virtually, in person, or through a combination of both. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process.

 

~ The Acentra Health Talent Acquisition Team

 

Visit us at http://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.

 

 

Experience in Lieu of Degree

 

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

 

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.”

Pay Range: USD $28.37 - USD $38.00 /Hr.

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Demonstrates compliance with all product’s specific performance metrics Regular, reliable attendance and timeliness Must work 4 weekend shifts per month- either in every Saturday schedule or every other weekend. Other duties as assigned Education: Current, unrestricted, RN licensure in a compact state which is your state of residence. Licensure in other States as required by law or client contract will be assigned within 30 days of hire. Must reside in a compact state and maintain a compact multistate license. Current home state RN license in good standing. Registered nurse is responsible and accountable for safe clinical practice, knowledgeable of customers and regulatory expectations in the clinical area. Minimum of an associate degree from a two-year college or technical school or Diploma Nursing Program; BSN preferred. CEU subscription provided at hire- use with Carenet Health email- RNs required to maintain mandatory number of credits per year to maintain all assigned license. RN must attend training 100% of hours and must pass intra-training testing components. Experience: Minimum 3 years of Registered Nurse clinical experience. Experience in ER, adult and pediatric care, Medical/Surgical, Home Health and Hospice or other acute areas preferred. Telephone triage experience and understanding of health benefit plans and the insurance industry are helpful, but not required. Bilingual skills are a plus. Functional/Technical Knowledge, Skills and Abilities Required: Ability to apply clinical knowledge to effectively meet clinical business standards. Fully competent in product delivery and business requirements. Ability to run multiple computer programs at the same time. Identify opportunities for improvement and recommend workable solutions. Exercises judgement within defined practices and procedures to determine appropriate action. Ability to determine when to escalate issues appropriately and in a timely manner. Builds rapport with members and effectively influences member behavior. Comprehensive communication (listening, reflection, and clarification) skills. Manages time effectively. Must currently reside and have a Multi-State (compact) unrestricted RN license in one of the following states: AL, AR, CO, FL, GA, IA, ID, IN, KS, KY, LA, ME, MS, MO, MT, NE, NM, NC, ND, NH, OK, SC, SD, TN, TX, VA, WI, WY Ability to become licensed in additional states as required More important information: Full-time positions available (36-40 hours per week) Your schedule will be evenings and will include at least two weekend days every two weeks. Differential pay may be earned for certain shifts. Training is 2-4 weeks, with the first two weeks during daytime hours. 100% Attendance is required. Training is done in a virtual, interactive classroom setting. For work-from-home positions, your home office must meet certain certification requirements that would be explained to you during the interview process. Compensation & Benefits At Carenet Health, we value the expertise and dedication of our team members, and we are committed to offering an appealing compensation package. The salary range for the Registered Nurse role is $34.00 per hour. In addition, we offer a comprehensive benefits package that includes health, dental, and vision insurance, a 401(k) plan with company match, paid time off (PTO) and holidays, flexible spending accounts (FSAs), employee wellness programs, and career development opportunities. Additional Information Note: Completion of assessments may be required before an applicant can move forward. Completing assessments must be done independently. Any discovery of unauthorized completion, whether during or after the hiring process, will result in disqualification or termination. Carenet Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. Please note that we are not accepting resumes for this position from external staffing agencies or recruiters. To be considered for this role, please submit your application directly through our official career portal.