CNSI and Kepro are now Acentra Health!  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.

Description

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

Position Overview

Acentra Health is seeking (RN) Clinical Assessors statewide in Virginia for an exciting opportunity. You will work out of your home office and travel to assessment locations in your region. The RN Clinical Assessor serves a unique dual role as a care coordinator: completion of needs-based assessments of level of care (LOC) to allow targeted individuals to remain in or return to a home and community-based setting. Assessments are generally performed in the beneficiary’s primary residence; and as a pre-authorization nurse: reviews requests for medical treatments, services, or procedures for Medicaid fee-for-service services. Pre-authorization reviews require nurses to assess, evaluate, and provide recommendations to help ensure members receive the services they need.

Job Responsibilities

• Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care and determines if the medical record documentation supports the need for services.
• Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions ensuring the reason for the denial is described in sufficient detail in correspondence.
• Fosters positive and professional relationships and acts as liaison with internal and external customers to ensure effective working relationships and team building in order to facilitate the review process.
• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
• Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
• Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures, and guidelines.
• Actively cross-trains to perform duties of other contracts within the Acentra Health network to provide a flexible workforce to meet client/consumer needs.
• Other duties as assigned.

Required Experience, Knowledge and Skills

• Active unrestricted RN license in the State of Virginia or a compact state license.
• Strong clinical assessment and critical thinking skills.
• 1+ years Utilization Review (UR) and/or Prior Authorization or related experience.
• 3+ years of direct experience in a clinical setting or other applicable State and/or Compact State clinical experience or license per contract requirements.
• Knowledge of InterQual or ASAM criteria.
• Knowledge of current NCQA/URAC standards.
• Experience in completing retrospective reviews and long-term acute care hospital reviews.
• Knowledge of InterQual or ASAM guidelines.
• Ability to prioritize, assign, and follow up on work.
• Ability to problem solve.
• Ability to provide technical consultation and policy interpretation.
• Excellent customer service.
• Excellent written and verbal communication skills.
• Microsoft Office basic skills.

For further consideration, please promptly apply on our Careers site using the following link: https://apply.workable.com/kepro/j/003CD38EB9

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

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

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 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 law.