RN Clinical Assessor/ UM Reviewer - Hybrid (NOVA)

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.RN Clinical Assessor/ UM Reviewer - Hybrid (NOVA)

Are you an experienced RN Clinical Assessor/ UM Reviewer in Northern Virginia 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!Who we need:Acentra Health is seeking RN Clinical Assessors/ UM Reviewers in northern 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/Reviewer 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. 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 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:

Conducts assessment to determine whether the beneficiary meets the conditions and criteria for CMS wavier eligibility, using state-approved standardized assessment tool(s).

Establish a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality outcomes.

Interact and collaborate with multidisciplinary care team, which includes physicians, nurses, case managers, pharmacists, and social workers/educators to ensure beneficiary needs and preferences for health services/information is shared; educates beneficiaries about community resources/options; advocates on behalf of the beneficiary.

Prepare documentation, status updates, event notifications and other documentation regarding beneficiaries in accordance with regulatory requirements and company policies and procedures.

Monitor case load to ensure all required documentation and entry of assessment results into web-based database are completed accurately and timely.

Attend and actively participate in staff meetings and conduct case consultations/peer reviews/internal auditing as assigned.

Reviews and interprets patient records and compares against criteria to determine medical necessity and appropriateness of care; 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 reason for the denial is described in sufficient detail on correspondence.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.What you’ll need:Required Qualifications· Registered Nurse licensed by the state of Virginia · Minimum of two years’ experience in home care setting preferred. Knowledge, Skills, Abilities· Knowledge of standards of practice related to Medicaid waivers, home, and community-based services (HCBS) programs, EPSDT, medical fragility, and level of care determinations. · Develops level of care recommendations based upon clinical evaluations. · Ability to use person-centered thinking, planning, and have competency in awareness of the needs of persons with disabilities. · Ability to interact with healthcare professionals, patients, their families, and other supports. · Knowledge of InterQual criteria strongly preferred. · Knowledge of current NCQA/URAC standards strongly preferred · Medical record abstracting skills required. · Knowledge of the organization of medical records, medical terminology, and disease process required. · Strong clinical assessment and critical thinking skills required. · Excellent verbal and written communication skills required. · Ability to work in a team environment. · Flexibility and strong organizational skills needed. · Computer proficiency in Microsoft Excel, Word and Outlook. · Ability to utilize computer equipment and web-based software to conduct work Experience

Experience with community-based individuals needing personal assistance with ADL and IADL tasks is highly preferred.

1+ years of experience (preferably case management) in the health or medical field, directly related to homecare, long-term care, or personal care is required.

Minimum of one year UR and/or Prior Authorization or related experience.

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 TeamEOE AA M/F/Vet/DisabilityAcentra 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.