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Position Overview:
As a Absence Management Clinical Reviewer, you'll leverage your clinical expertise to review medical records against specific criteria, contract requirements, and apply critical thinking to assess the medically appropriate level of care. Your role is pivotal in maintaining production goals and upholding QA standards. You'll ensure day-to-day processes comply with NCQA, URAC, and other industry standards.
Flexibility in working hours may be required based on contract demands and leadership requests. Moreover, flexibility in working hours may be imperative to accommodate dynamic contract demands and leadership directives.
Key Responsibilities:
- Review of patient records and medical certification documents to determine FMLA eligibility for continuous and intermittent leaves in accordance with the DOL Regulations, State Guidelines, and Client Policies.
- Accurately and promptly abstract review-related data onto appropriate review tools and submit administrative documents as required.
- Continuously reassess the review process, identifying opportunities for enhancement or change.
- Cultivate positive relationships with internal and external stakeholders, facilitating effective teamwork and streamlined review processes.
- Attend training sessions and meetings, maintaining up-to-date information and knowledge for reviews.
- Safeguard medical records' confidentiality through proper computer access and adherence to HIPAA policies.
- Employ appropriate communication techniques in verbal and written interactions following Acentra Health guidelines.
- Actively cross-train to perform duties across various contracts within the Acentra Health network, ensuring adaptability to meet client needs.
Required Qualifications, State Liscenses, Skills and Experience
- Active, unrestricted RN Clinical License.
- Graduation from an accredited Diploma, Associate, or Bachelor's Degree program.
- At least two years or more of direct clinical experience in an acute or med-surgical environment.
- Minimum of one year of Utilization Review and FML Administration experience.
- Strong clinical assessment and critical thinking skills are essential.
- Proficiency in medical record organization, medical terminology, and disease processes.
- Familiarity with InterQual criteria is highly beneficial.
- Knowledge of current Department of Labor Regulations.
- Proficiency in medical record abstracting.
- Excellent verbal and written communication skills.
- Flexibility, strong organizational skills, and proficiency in Microsoft Office and internet navigation.
- Ability to work effectively within a team environment
At Acentra Health, we uphold a strong commitment to Equal Employment Opportunity, valuing diversity, equity, inclusion, and a sense of belonging within our workforce. Our organization thrives on fostering a culture of continuous learning, development, and abundant opportunities for career growth.
Your instrumental role will be pivotal in advancing our mission of delivering the resources and exceptional care for our patients/members within the communities we serve!
Come and embark on a journey filled with exciting possibilities and a world of opportunities awaiting you, apply now!
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 Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!
~ The Acentra Health Talent Acquisition Team
EOE AA M/F/Vet/Disability
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 laws.
Acentra Health
