Clinical Review Manager (Remote)

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 Manager of Clinical Review to join our growing team.

Job Summary:

• The Clinical Review Manager is accountable for effectively managing and overseeing all Review Operations activities, ensuring adherence to clinical, contractual, and budgetary parameters.

Responsibilities:

• Advise and manage direct reports on operational standards, policies and procedures, quality monitoring, and educational needs.
• Ensure the timely completion of all contract deliverables related to Review Operations.
• Ensure that all review activities are performed in a timely manner.
• Prepare and submit required reports on time.
• Assist in achieving annual organizational priorities and operational indicators.
• Act as a liaison between the contract/provider and customers for addressing customer service issues and resolving problems; act as a liaison for internal customers.
• Foster and maintain strong communication links with internal and external customers through various means, such as one-on-one meetings, team meetings, and interdepartmental meetings.
• Provide oversight of Review Operations activities, including processes, staff development, internal training, external training (providers) where required, the quality of the review processes, and deliverables.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications

• AHIMA hospital-based coding credentials required.
• RHIA or RHIT Certification
• Bachelor's Degree or equivalent directly applicable experience in Health Information Management, Nursing, Healthcare Administration or related area is preferred.
• 5+ years of hospital clinical coding experience required.
• 3+ years of hospital utilization review experience required.

Preferred Qualifications

• Active RN licensure preferred;
• Proficiency in Microsoft software applications (Word, Excel, PowerPoint, Access).
• Capability to take initiative, supply leadership, maintain confidentiality, meet deadlines, and work in a team environment.
• Excellent verbal and written communication skills.
• Customer-focused, results-oriented and capable of building and maintaining relationships with internal and external customers.
• Knowledge of CQI tools preferred.
• Organizational skills, ability to plan and prioritize multiple assignments essential.
• Skill in examining and re-examining operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
• Knowledge of U.S. healthcare industry; preferably with experience in both public and private sector.
• Demonstrate expertise in managing differing customer needs.
• Ability to participate as a team member fostering collaborative decision-making among leadership, committees, teams or work groups.

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

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

Visit us at Acentra.com/careers/

EEO 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.

Compensation

The pay range for this position is listed below.

"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."