Experienced Clinical Reviewer – LPN/LVN for Remote U. S. Healthcare Solutions

Join Acentra Health: Empowering Better Health Outcomes Through Technology and Clinical Expertise Acentra Health is at the forefront of innovating health solutions that deliver maximum value and impact. As a vital partner for health solutions in the public sector, we empower better health outcomes through a unique blend of technology, services, and clinical expertise. Our mission is built on a foundation of passion, innovation, and a commitment to making a genuine difference in people's lives nationwide. Our Rallying Cry: Lead the Way At Acentra Health, 'Lead the Way' is more than just a slogan – it's an open invitation to embrace our mission, engage in problem-solving, and take ownership of your work every day. We're not just looking for employees; we're looking for passionate individuals who are dedicated to being part of a team that redefines expectations for the healthcare industry. If you're ready to accelerate your career and contribute to better health outcomes, we've got a place for you. Clinical Reviewer – LPN/LVN (Remote U. S.): Job Summary and Responsibilities We're seeking an experienced Clinical Reviewer – LPN/LVN to join our growing team. As a Clinical Reviewer, you will play a critical role in reviewing medical records against criteria, contract requirements, and regulatory standards. Your expertise will be instrumental in determining medical appropriateness while meeting production goals and quality assurance standards. This is a remote opportunity that offers the flexibility to work from anywhere across the U. S., with a schedule that includes five eight-hour shifts with alternating weekends, 9:00 AM to 6:00 PM Eastern. Key Responsibilities: Assure accuracy and timeliness of all applicable review type cases within contract requirements, ensuring precision and compliance in medical record reviews. Assess, evaluate, and address daily workload and queues; adjust work schedules daily to meet the workload demands of the department, showcasing flexibility and strong organizational skills. In collaboration with your Supervisor, be responsible for quality monitoring activities, maintaining a high level of quality in your work. Maintain a current knowledge base related to review processes and clinical practices, serving as the initial resource to nurse reviewers regarding all review process questions and/or concerns. Function as a liaison for providers' customer service issues and problem resolution, fostering positive and professional relationships with internal and external customers. Perform all applicable review types as workload indicates, demonstrating adaptability and a willingness to take on various challenges. Attend training and scheduled meetings to stay updated on current information, committing to ongoing learning and professional development. Cross-train and perform duties to provide a flexible workforce that meets client/customer needs, showcasing your ability to work in a team environment. Read, understand, and adhere to all corporate policies, including those related to HIPAA and its Privacy and Security Rules, ensuring confidentiality and compliance. Qualifications: What We're Looking For Required Qualifications/Experience: Active, unrestricted LPN/LVN license in the state of Indiana or a Compact state clinical license, as per contract requirements. A minimum of a diploma or certificate in Practical Nursing, laying the foundation for your clinical expertise. 3+ years of clinical experience in an acute, behavioral health, and/or med-surgical environment, providing a strong background in clinical practices. 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization experience, demonstrating your understanding of review processes. 2+ years of knowledge of medical necessity review experience, showcasing your critical thinking skills. 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG), highlighting your familiarity with industry-standard criteria. Proficiency in navigating multiple systems with the ability to switch between systems seamlessly and effectively, underscoring your technical skills. Strong clinical assessment and critical thinking skills, essential for determining medical appropriateness. Excellent written and verbal communication skills, vital for effective liaison and customer service roles. Flexibility and strong organizational skills, necessary for managing daily workload and meeting production goals. Preferred Qualifications/Experience: Knowledge of current National Committee for Quality Assurance (NCQA) standards, adding an extra layer of quality to your work. Knowledge of Utilization Review Accreditation Commission (URAC) standards, further demonstrating your commitment to industry standards. Ability to work in a team environment, collaborating with others to achieve common goals. Proficiency in Microsoft Office, facilitating efficient documentation and communication. Efficient time management, including the ability to prioritize tasks and meet deadlines, ensuring productivity and effectiveness. The ability to maintain confidentiality standards and ensure HIPAA compliance, reflecting your understanding of the importance of privacy and security. Why Choose Acentra Health? At Acentra Health, we're not just a company; we're a community of experienced and caring leaders, clinicians, technologists, and industry professionals who come together to make a difference. Here's what you can expect when you join our team: Meaningful work that genuinely improves people's lives nationwide, giving you a sense of purpose and fulfillment. A culture that cares about our employees, providing the tools and encouragement you need to achieve your best work. Opportunities for career growth and professional development, helping you to accelerate your career. A competitive pay range of USD $22.69 - USD $32.70 /Hr., recognizing your value and expertise. A comprehensive benefits package and perks that support your well-being and work-life balance. Ready to Lead the Way? If you're a motivated and compassionate Clinical Reviewer – LPN/LVN looking for a challenging and rewarding role, we want to hear from you. Join Acentra Health and be part of a team that's dedicated to empowering better health outcomes through technology, services, and clinical expertise. Apply now and take the first step towards a fulfilling career that makes a real difference. We appreciate your interest in Acentra Health. While we can't respond to every application individually, we invite you to apply to future openings that may interest you. Thank you for considering a career with us! Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law. Apply for this job