Clinical Reviewer PT/OT/SLP - PRN Licensed in State of Arkansas (Remote U.S.)

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.

Clinical Reviewer PT/OT/SLP - PRN (Remote U.S.)

• Are you an experienced PT, OT, OR SLP Clinical Reviewer looking for a new challenge?
• Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?

If so, you might be our next new team member!

** This role is PRN only. **

** This is a Remote-based role that requires the selected candidate to work and reside in the U.S. **

Who we need:

The Clinical Reviewer in Physical Therapy, Occupational Therapy OR Speech Therapy:

• Utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and Quality Assurance standards.
• Ensures day-to-day processes are conducted in accordance with NCQA, URAC, and other regulatory standards.

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.

Singularly Focused. Mission Driven.

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

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.

What you’ll do:

• Review and interpret patient records and compare against criteria to determine medical necessity and appropriateness of care; determine if the medical record documentation supports the need for services.
• Determine approval or initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for the denial is described in sufficient detail in correspondence.
• Abstract review related data/information accurately and timely on the appropriate review tool by the appropriate means.
• Accurate and timely submission of all administrative and review-related documents to appropriate parties.
• Perform ongoing reassessment of the review process to offer improvement and/or change opportunities.
• Foster 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.
• Responsible for attending training and scheduled meetings and maintaining and using current/updated information for review.
• Always maintain medical records confidentiality through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
• Utilize proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures, and guidelines.
• Actively cross-train to perform duties of other contracts within the Acentra Health network to provide a flexible workforce to meet client/consumer needs.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

What you’ll need:

Required Qualifications

• Master’s degree in Physical OR Occupational OR Speech Therapy, licensed in the State of Arkansas in good standing with a sp