Company Overview:
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.
Job Summary and Responsibilities:

JOB SUMMARY:

Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with regulatory benchmarks, ensuring precision and compliance in medical record reviews.

REQUIRED QUALIFICATIONS/EXPERIENCE:

• Active, unrestricted LPN/LVN license in the state of Indiana or a Compact state clinical license, per contract requirements.
• A minimum of a diploma or certificate in Practical Nursing for an LPN/LVN.
• 3+ years of clinical experience in an acute, behavioral health, and/or med-surgical environment.
• 2+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization.
• 2+ years of knowledge of medical necessity review experience.
• 1+ years of knowledge of InterQual criteria, Milliman Care Guidelines (MCG) and/or other state/nationally recognized criteria.
• Proficient in navigating multiple systems with the ability to switch between systems seamlessly and effectively.
• Strong clinical assessment and critical thinking skills.
• Excellent written and verbal communication skills.
• Flexibility and strong organizational skills.

PREFERRED QUALIFICATIONS/EXPERIENCE:

• An Associate, Diploma or Bachelor’s degree from an accredited college or university in a related field for an LPN/LVN.
• Knowledge of current National Committee for Quality Assurance (NCQA) standards
• Knowledge of Utilization Review Accreditation Commission (URAC) standards.
• Ability to work in a team environment.
• Proficient in Microsoft Office.
• Efficient time management, including the ability to prioritize tasks, and meet deadlines.
• Exhibit the ability to maintain confidentiality standards and ensure HIPAA compliance when assessing relevant issues.
  

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“BASED ON OUR COMPENSATION PHILOSOPHY, AN APPLICANT’S POSITION PLACEMENT IN THE PAY RANGE WILL DEPEND ON VARIOUS CONSIDERATIONS, SUCH AS YEARS OF APPLICABLE EXPERIENCE AND SKILL LEVEL.”

Pay Range: USD $28.37 - USD $32.70 /Hr

• 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 related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
• Functions as providers’ liaison for customer service issues and problem resolution.
• Performs all applicable review types as workload indicates.
• Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Attends training and scheduled meetings for current/updated information.
• Cross trains and perform duties to provide flexible workforce to meet client/customer needs.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.