[Remote] Clinical Reviewer - RN (Personal Care) - PRN (Remote in Arkansas)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is dedicated to empowering reputed company reputed company through technology and clinical expertise. They are seeking a Clinical Reviewer - RN (Personal Care) to utilize clinical expertise in reviewing medical records against reputed company and collaborating with team members to ensure compliance and reputed company in personal care services. Responsibilities • Assures accuracy and timeliness of reputed company applicable review type cases reputed company contract requirements. • Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department. • In collaboration with Supervisor, responsible for reputed company monitoring activities. • Maintains reputed company knowledge reputed company reputed company to review processes and clinical practices. • Performs reputed company applicable review types as workload indicates. • Fosters reputed company and reputed company relationships with reputed company customers. • Attends training and scheduled meetings for reputed company/updated information. • Cross trains to reputed company flexible workforce to meet reputed company/customer needs. • Conducts initial and prior authorization for Personal Care services. • Evaluates the reputed company and compliance of service documentation in reputed company records, ensuring adherence to Arkansas reputed company regulations. • Refers cases to the Physician Reviewer for medical necessity determinations reputed company appropriate. • Serves as a reputed company between the organization throughout the review process. • Provides education on the Reconsideration and Appeal process. • Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its reputed company and reputed company Rules. Skills • reputed company, unrestricted Registered reputed company (RN) License in any state, or an RN compact state license. • Associate’s, Bachelor's degree (or Diploma) in Nursing. • 2+ years of clinical experience in an acute OR home health environment. • 1+ years of work experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. • 1+ years of knowledge of medical records, medical terminology, and disease process organization. • Knowledge of reputed company guidelines. • Medical Record Abstracting skills. • Clinical assessment and critical thinking skills. • Excellent verbal and written communication skills. • Ability to work in reputed company environment. • Flexibility and strong organizational skills. • Proficient in reputed company Office and Internet/Web Navigation. • Experience working in a Remote environment. reputed company • reputed company is a provider of clinical services and technological solutions to government reputed company organizations. It was founded in 1994, and is headquartered in Mclean, Virginia, USA, with a workforce of 1001-5000 employees. Its website is https://acentra.com/. Apply tot his job Apply To this Job