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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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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. 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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Summary As a Nurse Reviewer - Remote North Dakota at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable.
$49,200 - $70,300 a yearWork from homeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Summary As a Nurse Reviewer - Remote Wyoming at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable.
$49,200 - $70,300 a yearRemoteExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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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! Knowledge of current National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Committee (URAC) standards.
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1+ year of Utilization Review (UR) and/or Prior Authorization or related work experience. Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards. Experience with Substance Use (ARTS.
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Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Always maintain medical records confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
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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. 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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Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP’s Compliance Special Investigations Unit (SIU.
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Experience with Applied Behavioral Analysis (ABA) Determine approval or initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for the denial is described in sufficient detail in correspondence.
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Our mission is to innovate health solutions that deliver maximum value and impact. 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.
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The Acentra Health Talent Acquisition Team. Ability to provide technical consultation and policy interpretation. You will have meaningful work that genuinely improves people's lives nationwide. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.
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Position is remote but candidates must be located within the State of Virginia. We know your time is valuable, and we thank you for applying for this position. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career.
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Your clients will have already completed a UAS evaluation with a Registered Nurse, and your role will be to determine whether MLTC and home care services are adequate for the patient’s care, or if they should instead be admitted to a supportive facility.
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Summary As a Nurse Reviewer - Remote Louisiana at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable.
$49,200 - $70,300 a yearWork from homeExpandApply NowActive JobUpdated 2 days ago
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