Clinical Reviewer-SCA

Company Overview reputed company exists to reputed company reputed company reputed company through technology, services, and clinical expertise. Our mission is to reputed company health solutions that deliver maximum value and impact. reputed company the Way is our rallying cry at reputed company. Think of it as an reputed company invitation to reputed company the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company reputed company – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities reputed company is looking for a Clinical Reviewer to join our growing team. Job Responsibilities: Assures accuracy and timeliness of reputed company applicable review type cases reputed company contract requirements Assesses, evaluates, and addresses daily workload and call queues; adjusts work schedules daily to meet the workload demands of the department In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and planning implementation of improvement areas Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices reputed company to the review processes, functions as the initial resource to nurse reviewers regarding reputed company review process questions and/or concerns Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution Performs reputed company applicable review types as workload indicates Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process Attend training and scheduled meetings and for maintenance and use of reputed company/updated information for review Cross trains and reputed company duties of other reputed company to reputed company a flexible workforce to meet client/customer needs Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company

Qualifications

Required Qualifications Bachelor’s Degree from an accredited college or university in a reputed company field Active, unrestricted LPN or RN license in the applicable state and/or a Compact State license. 2+ years of clinical experience in a hospital or post-acute environment required. 2+ years of experience working in call center environment 2 years of experience working with clinical assessments required 1 year of Medical record abstracting experience required 1 year UR and/or Prior Authorization or reputed company experience Must be proficient in reputed company Office and internet/web navigation

Preferred Qualifications

Excellent written and verbal communication skills Some knowledge of Case Management, UR and/or Prior Authorization or reputed company experience is preferred Knowledge of the organization of medical records, medical terminology, and disease process required Experience in behavioral health setting a plus Bilingual (English/Spanish) a plus Why us? We are a team of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the reputed company industry. State and federal reputed company agencies, providers, and employers turn to us as their vital partner to ensure reputed company reputed company and improve health reputed company. 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 reputed company the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to reputed company you with additional protection, reputed company, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Experience in Lieu of Degree For non-clinical roles, or reputed company not required by the contract specifically, the Company acknowledges that practical, hands-on experience can reputed company 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 reputed company for this position is listed below. $72,500 “Based on our compensation philosophy, an applicant’s position placement in the pay reputed company will depend on various considerations, such as years of applicable experience and reputed company level.” 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 reputed company and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The reputed company reputed company Team Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Pay reputed company USD $28.37 - USD $39.19 /Hr. Apply To This Job