Clinical Reviewer

1 week ago


Charleston, West Virginia, United States CNSI Full time
Job Summary

The Clinical UM Reviewer RN will play a critical role in reviewing medical records against contract requirements to determine medical appropriateness. This position requires strong clinical assessment and critical thinking skills, as well as excellent written and verbal communication skills.

Key Responsibilities
  • Assure accuracy and timeliness of all applicable review type cases within contract requirements.
  • Assess, evaluate, and address daily workload and queues; adjust work schedules daily to meet the workload demands of the department.
  • Collaborate with Supervisor to identify areas of improvement and implement quality monitoring activities.
  • Maintain current knowledge base related to review processes and clinical practices.
  • Function as the initial resource to nurse reviewers regarding review process questions and concerns.
  • Perform all applicable review types as workload indicates.
  • Foster positive and professional relationships with internal and external customers.
Requirements
  • Active unrestricted RN or Social Worker license per contract requirements.
  • Bachelor's Degree from an accredited college or university in a related field.
  • Knowledge of medical records, medical terminology, and disease process required.
  • Strong clinical assessment and critical thinking skills required.
Why Work with Us?

Acentra Health is a team of experienced and caring leaders, clinicians, and industry professionals who come together to redefine expectations for the healthcare industry. We are a vital partner to state and federal healthcare agencies, providers, and employers, working to ensure better healthcare and improve health outcomes.

We offer a comprehensive benefits package, including health plans, paid time off, retirement savings, corporate wellness, educational assistance, and more. Our compensation program offers a competitive rate, with opportunities for growth and advancement.



  • Charleston, West Virginia, United States Summit BHC Full time

    Job SummarySummit BHC is seeking a highly skilled Clinical Utilization Review Specialist to join our team. As a key member of our healthcare team, you will be responsible for reviewing and managing the utilization of healthcare services to ensure that they are medically necessary and meet the standards of our organization.Key ResponsibilitiesConduct thorough...


  • Charleston, West Virginia, United States Acentra Health Full time

    About the RoleAcentra Health is seeking a highly skilled Customer Service Representative/Review Assistant to join our team. As a key member of our organization, you will play a crucial role in supporting our review process by providing exceptional customer service and ensuring the smooth operation of our services.Key ResponsibilitiesCustomer Service: Respond...

  • Clinical Pharmacist

    2 days ago


    Charleston, West Virginia, United States Potomac Healthcare Solutions Full time

    Job Title: Clinical PharmacistWe are seeking a highly skilled Clinical Pharmacist to join our team at Potomac Healthcare Solutions. As a Clinical Pharmacist, you will play a critical role in providing patient-centered care and ensuring the safe and effective use of medications.Key Responsibilities:Counsel patients on appropriate medication use and monitor...


  • Charleston, West Virginia, United States Alcanza Clinical Research Full time

    Job OverviewAlcanza Clinical Research is a dynamic and expanding organization engaged in multi-site, multi-phase clinical trials across various therapeutic areas, including vaccine research, neurology, dermatology, psychiatry, and general medicine. We are committed to maintaining high standards in clinical research and laboratory operations.Position...

  • Clinical Specialist

    6 days ago


    Charleston, West Virginia, United States Sevita Full time

    Clinical SpecialistSevita is a leading provider of home and community-based specialized healthcare services. We believe that everyone deserves to live a full, more independent life.As a Clinical Specialist, you will provide invaluable support to individuals with intellectual and developmental disabilities, brain injuries, or mental health conditions. Your...


  • Charleston, West Virginia, United States Medix™ Full time

    Position Overview:The Clinical Trials Coordinator plays a crucial role in ensuring that Institutional Review Board (IRB) approved protocols are effectively executed and adhered to. This position involves overseeing the informed consent process, monitoring patient safety and status, and systematically collecting and organizing research data.Key...


  • Charleston, West Virginia, United States Medix™ Full time

    Position Overview:The Clinical Research Specialist plays a crucial role in ensuring that Institutional Review Board (IRB) approved protocols are executed effectively. This position involves managing the informed consent process, monitoring patient well-being and safety, and meticulously collecting and organizing research data.Key Responsibilities:● Prepare...


  • Charleston, West Virginia, United States Roper St. Francis Full time

    Job SummaryRoper St. Francis Healthcare is seeking a highly skilled Clinical Research Nurse to join our team. As a Clinical Research Nurse, you will play a critical role in ensuring the integrity and quality of clinical trials, while protecting the health, safety, and welfare of research participants.Key ResponsibilitiesCoordinate research studies in a team...

  • Clinical Pharmacist

    6 days ago


    Charleston, West Virginia, United States CAMC Health System Full time

    Job SummaryAs a Clinical Staff Pharmacist, you will play a critical role in managing the medication use process, ensuring the safe and effective use of medications throughout the medical center. You will apply your knowledge of drugs and drug therapy to provide high-quality patient care and treatment.ResponsibilitiesReview medication orders and enter them...


  • Charleston, West Virginia, United States Shenandoah Center - Charles Town, WV Full time

    Shenandoah Center - Charles Town, WVSeeking a Clinical Reimbursement SpecialistWe are seeking a highly skilled Clinical Reimbursement Specialist to join our team at Shenandoah Center in Charles Town, WV. As a Clinical Reimbursement Specialist, you will be responsible for ensuring accurate and timely completion of Medicare/Medicaid case-mix documents,...

  • Clinical Pharmacist

    2 weeks ago


    Charleston, West Virginia, United States CAMC Health System Full time

    Job SummaryAs a Clinical Staff Pharmacist at CAMC Health System, you will play a critical role in managing the medication use process, ensuring the safe and effective use of medications throughout the medical center. This position requires a strong foundation in pharmacology and a commitment to delivering high-quality patient care.Key ResponsibilitiesReview...


  • Charleston, West Virginia, United States Genesis HealthCare - Charleston, WV Full time

    Job SummaryWe are seeking a highly skilled and experienced Regional Clinical Strategist to lead our clinical programing and drive clinical niche opportunities in the Charleston, WV market. As a key member of our leadership team, you will be responsible for developing and implementing strategic plans to improve clinical quality and patient outcomes.Key...


  • Charleston, West Virginia, United States Genesis HealthCare - Parkersburg, WV Full time

    Job SummaryWe are seeking a highly skilled and experienced Regional Clinical Strategist to lead our clinical programming and market-driven clinical niche opportunities in the Parkersburg, WV area. As a key member of our team, you will be responsible for developing strategic plans for process and quality improvement within the market, collaborating with...


  • Charleston, West Virginia, United States Roper St. Francis Full time

    Job SummaryRoper St. Francis Healthcare is seeking a highly skilled Clinical Research Nurse to join our team. As a Clinical Research Nurse, you will play a critical role in ensuring the integrity and quality of clinical trials, while promoting the health, safety, and welfare of research participants.Key ResponsibilitiesStudy Coordination: Coordinate research...


  • Charleston, West Virginia, United States Genesis HealthCare - Charleston, WV Full time

    Position Overview:As a key player in our organization, the Regional Clinical Consultant will spearhead the strategic vision for clinical programming and identify market-driven clinical opportunities to fulfill the healthcare needs of our nursing centers. This role is pivotal in ensuring clinical excellence and innovation across the designated market.Key...


  • Charleston, West Virginia, United States Genesis HealthCare - Charleston, WV Full time

    Job SummaryWe are seeking a highly skilled and experienced Regional Clinical Strategist to lead our clinical programing and market-driven clinical niche opportunities in the Charleston, WV area. The successful candidate will assume ultimate responsibility for the team's clinical successes and innovation within the market.Key ResponsibilitiesCollaborate with...

  • Clinical Therapist

    2 days ago


    Charleston, West Virginia, United States Roper St. Francis Full time

    Job Title: Clinical TherapistJoin Roper St. Francis Healthcare as a Clinical Therapist and play a vital role in the continuity of care for patients with psychiatric problems. As a member of our interdisciplinary team, you will work closely with patients, families, and healthcare professionals to provide comprehensive care and support.Key...


  • Charleston, West Virginia, United States Shenandoah Center - Charles Town, WV Full time

    Shenandoah Center - Charles Town, WVSeeking a Skilled MDS Coordinator - RNWe are seeking a highly skilled and experienced MDS Coordinator - RN to join our team at Shenandoah Center in Charles Town, WV. As a key member of our clinical team, you will be responsible for ensuring the timely and accurate completion of the MDS treatment assessment tool and...

  • Clinical Pharmacist

    1 week ago


    Charleston, West Virginia, United States Potomac Healthcare Solutions Full time

    Clinical Pharmacist Job DescriptionPotomac Healthcare Solutions is seeking a highly skilled Clinical Pharmacist to join our team. As a Clinical Pharmacist, you will play a critical role in providing patient care and ensuring the safe and effective use of medications.Key Responsibilities:Counsel patients on medication use and monitor medication therapy to...


  • Charleston, West Virginia, United States Heed Health Full time

    Job Summary:We are seeking a highly skilled and experienced Optometrist to lead our clinical operations as the Lead Optometrist at Heed Health. As a key member of our team, you will be responsible for providing exceptional eye care services to our patients and driving the success of our practice.About the Role:Full-time position with a competitive base...