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Clinical Reviewer

1 month ago

Harrisburg, Pennsylvania, United States Acentra Health Full time
About Acentra Health

Acentra Health is a leading provider of healthcare solutions, empowering better health outcomes through technology, services, and clinical expertise.

Job Summary

We are seeking a skilled Clinical Reviewer to join our team. As a Clinical Reviewer, you will utilize your clinical expertise to review medical records against appropriate criteria, applying critical thinking and decision-making skills to determine medical appropriateness.

Key Responsibilities
  • Reviews and interprets patient records to determine medical necessity and appropriateness of care
  • Initiates referrals to physician consultants and processes their decisions
  • Abstracts review-related data accurately and timely
  • Fosters positive relationships with internal and external customers
  • Maintains medical records confidentiality and adheres to HIPAA policies
Requirements
  • Active unrestricted LPN or RN State and/or Compact State license
  • Minimum two years of clinical experience in an acute, med-surgical, post-acute, or rehabilitation environment
  • Minimum of one year UR and/or Prior Authorization experience
  • Proficiency in computer skills, including Microsoft Office and internet/web navigation
  • Knowledge of current NCQA/URAC standards
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.

Why Choose Acentra Health?

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. Our company cares about our employees, giving you the tools and encouragement you need to achieve the finest work of your career.