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Clinical Reviewer

1 month ago

Fargo, North Dakota, United States CNSI Full time
Job Summary

Acentra Health is seeking a skilled Nurse Clinical Reviewer to join our team. As a key member of our clinical review team, you will utilize your clinical expertise to review medical records and determine medical necessity and appropriateness of care.

Key Responsibilities
  • Review and interpret patient records to determine medical necessity and appropriateness of care
  • Determine approval or initiate a referral to the physician consultant and process physician consultant decisions
  • Foster positive and professional relationships with internal and external customers to ensure effective working relationships and team building
  • Maintain medical records confidentiality and adhere to HIPAA policies
  • Utilize proper telephone etiquette and written communications following Acentra policies and procedures
Requirements
  • Active unrestricted RN license in the State of North Dakota or a compact state license
  • 1+ years of Utilization experience Review (UM) and/or Prior Authorization or related experience
  • 3+ years of direct experience in a clinical setting or other applicable State and/or Compact State clinical experience
  • Knowledge of InterQual or American Society of Addiction Medicine (ASAM) guidelines
  • Strong clinical assessment and critical thinking skills
Benefits

Acentra Health offers a comprehensive benefits package, including comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

The pay range for this position is $22.56/hr - $41.00/hr. Compensation will be based on various considerations, such as years of applicable experience and skill level.