[Remote] Clinical Reviewer - RN (Personal Care) - PRN (Remote in Arkansas)

Note:The job is a remote job and is open to candidates in USA. Acentra Health is dedicated to empowering better health outcomes through technology and clinical expertise. They are seeking a Clinical Reviewer - RN (Personal Care) to utilize clinical expertise in reviewing medical records against criteria and collaborating with team members to ensure compliance and quality in personal care services. Responsibilities• 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 workload demands of the department. • In collaboration with Supervisor, responsible for quality monitoring activities. • Maintains current knowledge base related to review processes and clinical practices. • Performs all applicable review types as workload indicates. • Fosters positive and professional relationships with internal and external customers. • Attends training and scheduled meetings for current/updated information.• Cross trains to provide flexible workforce to meet client/customer needs. • Conducts initial and prior authorization for Personal Care services. • Evaluates the quality and compliance of service documentation in client records, ensuring adherence to Arkansas Medicaid regulations. • Refers cases to the Physician Reviewer for medical necessity determinations when appropriate. • Serves as a liaison between the organization throughout the review process. • Provides education on the Reconsideration and Appeal process.• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. Skills• Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state license. • Associate’s, Bachelor's degree (or Diploma) in Nursing. • 2+ years of clinical experience in an acute OR home health environment. • 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. • 1+ years of knowledge of medical records, medical terminology, and disease process organization.• Knowledge of Medicaid guidelines. • Medical Record Abstracting skills. • Clinical assessment and critical thinking skills. • Excellent verbal and written communication skills. • Ability to work in a team environment. • Flexibility and strong organizational skills. • Proficient in bolthires Office and Internet/Web Navigation. • Experience working in aRemote environment. Company Overview• Acentra Health is a provider of clinical services and technological solutions to government healthcare organizations.It was founded in 1994, and is headquartered in Mclean, Virginia, USA, with a workforce of 1001-5000 employees. Its website is Apply tot his job