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

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Clinical Reviewer - RN (Personal Care) - PRN (Remote within Arkansas) to join our growing team. Job Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements. Completes prior authorization, for Personal Care services. Collaborates with the Clinical Director and Team Supervisor to: Define, review and document findings Monitor provider trends Recommend internal policies, procedures, and processes Collaborates with Team Supervisor and Medical Director to determine Medical Necessity of services. Serves as a resource for Personal Care providers. Assists Provider Relations Specialist with program-specific education and training. Maintains client privacy, confidentiality, and safety at all times. Ensures adherence to ethical, legal, and accreditation/regulatory standards.

Assures accuracy and timeliness of all applicable review type cases within 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 quality monitoring activities. Maintains current knowledge base related to review processes and clinical practices. Performs all applicable review types as workload indicates. Fosters positive and professional relationships with internal and external customers. Attends training and scheduled meetings for current/updated information. Cross trains to provide flexible workforce to meet client/customer needs. Conducts initial and prior authorization for Personal Care services. Evaluates the quality and compliance of service documentation in client records, ensuring adherence to Arkansas Medicaid regulations. Refers cases to the Physician Reviewer for medical necessity determinations when appropriate. Serves as a liaison between the organization throughout the review process. Provides education on the Reconsideration and Appeal process. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. ** This is a fully remote position where you must reside and work in the state of Arkansas. ** ** The hours for this PRN role, as well as turnaround time, would be discussed during the interview process. ** ** There is no required Travel for this role. **