Nurse Clinical Reviewer - RN (Remote U.S.)

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 company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers 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 seeks a Clinical Nurse Reviewer - RN (Remote U.S.) to join our growing team.

Job Summary:

The Clinical Nurse Reviewer - RN will analyze medical records to ensure compliance with clinical guidelines and policies.

 ** This is a Full-time, direct-hire position with Benefits.

** Workweek: Monday through Friday, typically 8:00 AM - 5:00 PM Eastern.

** You must have an active, unrestricted South Carolina RN License (or compact multi-state license).

** The selected candidate must reside in and work remotely from the U.S. 

Job Responsibilities:

• Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies.
• Review and analyze medical records to ensure compliance with clinical guidelines and policies.
• Communicate with healthcare professionals to obtain additional information needed for review.
• Conduct accurate and comprehensive reviews of medical records.
• Maintain detailed documentation of review findings and decisions.
• Participate in quality improvement initiatives to enhance patient care.
• Collaborate with team members to achieve departmental goals.
• 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 department's workload demands.
• In collaboration with the Supervisor, responsible for the quality monitoring activities, including identifying areas of improvement and plan implementation of improvement areas.
• Maintains a current knowledge base related to review processes and clinical practices related to them; functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
• Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Fosters positive and professional relationships and acts as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Attends training and scheduled meetings for maintenance and use of current/updated information for review.
• Cross-trains and performs duties of other contracts to provide a flexible workforce to meet client/customer needs.

Requirements

Required Qualifications/Experience:

• Active and unrestricted Registered Nurse (RN) license (must be an active South Carolina RN License or a compact multi-state license).
• 2+ years of nursing experience in a clinical setting.
• Associate’s Degree (or higher) in Nursing.
• Strong clinical knowledge and understanding of medical terminology.
• Excellent verbal and written communication skills.
• Detail-oriented with strong analytical and problem-solving skills.
• Ability to work independently while maintaining a high level of productivity.
• Knowledge of the organization of medical records, medical terminology, and the disease process.
• Strong clinical assessment and critical thinking skills.
• Ability to work in a team environment.
• Flexibility and strong organizational skills.
• Proficient in Microsoft Office Suite and internet/web navigation.

Preferred Qualifications/Experience:

• InterQual or other national clinical criteria (e.g., Milliman).
• Experience conducting accurate and comprehensive reviews of medical records.
• Knowledge of current National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Committee (URAC) standards.
• Medical record abstracting 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 nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career.

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 interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

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EOE 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, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.

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Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.  

Compensation

The pay range for this position is $28.00-36.00 hourly.

“Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”