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Ensures that there is evidence that the UM nurse reviewer documented communications with the requesting provider to validate the presence or absence of clinical information related to the criteria applied.
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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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Participates in inter-rater reliability (IRR) audits annually and maintains Reviewer Certification status. Participates in inter-rater reliability (IRR) audits annually and maintains Reviewer Certification status.
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Serve as the IT compliance reviewer for new system validations. Assist in IT Vendor Management. Serve as the IT compliance reviewer for new system validations. Maintain IT compliance calendar (quarterly SOX reviews and GxP changes, for example.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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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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Communicates between plan reviewer and the Engineer/Architect of Record. Irvine offers warm weather, beautiful scenery, and is a top bicycling city with miles of on-road bicycle lanes and mountain bike trails.
$69,600 - $129,600 a yearExpandApply NowActive JobUpdated Yesterday - 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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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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We are seeking a highly skilled and detail-oriented Batch Record Reviewer to join our Cell & Gene Manufacturing facility in Maryland, USA. In this role, you will be responsible for meticulously reviewing batch records to ensure accuracy, compliance, and adherence to regulatory standards.
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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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Serves occasionally as member for Global Clinical Development training programs, author or reviewer for clinical SOPs and may contribute to GCD strategy by serving on task-forces or other panels.
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reviewer job
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