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Our Behavioral Health UM Clinical Reviewer (RN, LCSW,LPC, and/or LBA) will use clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and QA standards.
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Knowledge of current National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Committee (URAC) standards. 1+ year of Utilization Review (UR) and/or Prior Authorization or related work experience.
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Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building to facilitate the review process. Responsible for attending training and scheduled meetings and maintaining and using current/updated information for review.
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Duties include supporting the contract administration lifecycle, including responding to inbound requests, contract review, interpretation, drafting and negotiating, routing requests to team members for response, signatures, and archiving, and maintaining confidentiality of work material.
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Develop, implement and review annually educational sanctions to promote restorative justice and community development. Use knowledge of due process, CSU and University- wide regulations, housing policies, landlord-tenant law, and contract law.
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Responsible for the review of upstream \(prime contract\) / downstream \(PO & subcontract\) change orders\. + Analyze data; review logs; and run reports in Oracle Primavera Contracts Manager software and/or the Oracle Financials MIS/PPS Accounting software.
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The Legal Intern will report directly to the Company's Assistant General Counsel and will provide an outstanding opportunity for law students to work on exciting legal issues and learn about all aspects of corporate law, including contract review, SEC and FINRA regulations, policy research, and corporate governance work.
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3+ years of direct experience in a clinical setting or other applicable State clinical experience or license per contract requirements. Review and interpret patient records and compare against criteria to determine medical necessity and appropriateness of care; determine if the medical record documentation supports the need for services.
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Track and monitors DHS shelter procurement consultation tasks and document review. Advises executive and senior leadership on contract and procurement issues related to shelter siting pursuant to the City’s homelessness plan, including selection of preferred procurement methods, the use of existing contracted goods and services, and recommendations for contract amendments.
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Active unrestricted Registered Nurse (RN) license, Licensed Clinical Social Worker (LCSW) license, Licensed Professional Counselor (LPC) license, or Licensed Behavioral Analyst (LBA) license in the State of Virginia.
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Experience with Community Based Mental Health Services (e.g. Case Management, TDT, IIH, MHSS, IOP) CNSI and Kepro are now Acentra Health! Acentra seeks a Behavioral Health UM Clinical Reviewer (PRN, Remote within Virginia) with an active RN, LCSW, LPC, and/or LBA to join our growing team.
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Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards. Experience with Substance Use (ARTS) Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise.
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Always maintain medical records confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies. 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.
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Key Words: RN Travel, Travel Nurse, Contract Nurse, Agency Nurse, Travel Contract, Travel Nursing, Case Manager, Case Management, Utilization Review, Case Manager RN. MedPro Healthcare Staffing is a Joint Commission certified provider of temporary and contract staffing services.
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MedPro Healthcare Staffing is a Joint Commission certified provider of contract staffing services. The role of the case management nurse (RN) is to coordinate continuity of care for patients often as a liaison between the patient’s family and healthcare organization.
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