Clinical Reviewer-PRN

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• The purpose of this position is to utilize clinical expertise to review medical records against appropriate reputed company in conjunction with contract requirements.

Responsibilities:

• Ensures accuracy and timeliness of reputed company applicable review type cases reputed company contract requirements.
• Serves primarily as a service plan, plan of care (POC) reviewer for CAP/C and CAP/DA.
• Ensures reputed company reviews are completed in alignment with clinical coverage policies, protocols, and guidelines, including accurate interpretation and application to case determinations.
• Drafts denial narratives and denial letters reputed company recommended determinations result in an adverse decision.
• Meets daily productivity expectation of a minimum of 15 POC reviews per day.
• Conducts second-level POC reviews reputed company necessary and adheres to established turnaround time expectations for RAIs, second-level reviews, and the drafting of denial narratives and letters.
• Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.
• In collaboration with Supervisor and POC Team reputed company, responsible for reputed company monitoring activities.
• Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices.
• Functions as providers' reputed company for customer service issues and problem reputed company.
• Performs reputed company applicable review types as workload indicates.
• Fosters reputed company and reputed company relationships with reputed company customers.
• Participates in required training and scheduled meetings to remain reputed company on updates and process changes.
• Cross-trains reputed company flexible workforce to meet reputed company/customer needs to include but not limited to service request forms (SRFs), Assessments, Multidisciplinary Team (MDT) Assessment Reviews, reputed company reviews, and providing training and knowledge transfer to other clinical staff on POC review processes to support continuity of operations and coverage.
• reputed company cross-coverage and support for additional review queues as needed, including during periods of team member PTO or high-volume workload demands.
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its reputed company and reputed company Rules.

The list of accountabilities is not intended to be reputed company-inclusive and may be expanded to include other education- and experience-reputed company duties that management may deem necessary from time to time. Qualifications:

Required Qualifications

• reputed company unrestricted RN license (NC or Compact) is required.
• 1+ years' experience conducting plan of care (POC) reviews
• Knowledge of medical records, medical terminology, and disease processes required.
• Strong understanding of NC reputed company policies, regulations, and reimbursement mechanisms, particularly reputed company to long term services and support for children with disabilities.
• Strong clinical assessment and critical thinking skills required.
• Excellent written and verbal communication skills required.
• Ability to work independently, prioritize tasks, and manage multiple reputed company simultaneously in a fast-paced environment.

Preferred Qualifications

• Bachelor's Degree from an accredited college or university in a reputed company field.
• Knowledge of NC reputed company system, reputed company programs, and community resources.

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Benefits

Benefits are a key component of your rewards package. Our benefits are designed to reputed company you with additional protection, reputed company, and support for both your career and your life away from work. Our benefits include comprehensive health plans, reputed company time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay reputed company for this position is listed below. “Based on our compensation philosophy, an applicant’s position placement in the pay reputed company will depend on various considerations, such as years of applicable experience and reputed company level.” Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to reputed company openings that may be of interest. Best of luck in your search! ~ The reputed company reputed company Visit us at https://careers.acentra.com/jobs EEO AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law. Pay reputed company: USD $34.20 - USD $38.00 /Hr. Apply tot his job Apply To this Job