Job 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.

  Clinical Review Manager

• Are you an experienced Clinical Review Manager 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:

The Clinical Review Manager will be responsible for the management and oversight of Review Operations activities within clinical, contractual, and budgetary parameters.

  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:

• Advises and manages direct reports relative to their responsibilities for Review Operations including but not limited to operational standards, policy and procedures, quality monitoring, and educational needs.
• Assures timely completion of all Review Operations related contract deliverables.
• Ensures that associated physician review activities are performed timely.
• Prepares and submits required reports on a timely basis.
• Assists in achieving annual organizational priorities and operational indicators.
• Functions as contract/provider liaison and contact/resource person for customer service issues and problem resolutions; functions as a liaison for internal customers.
• Foster and maintain strong communications links with internal and external customers through various means; e.g., one-on-one meetings, team meetings, and interdepartmental meetings.
• Provides oversight of Review Operations activities including processes, staff development, internal training, external training (providers) where required, the quality of the review processes, and deliverables.
• Ensures accountability of qualified nurses to organizational decisions affecting consumers.

  Required Qualifications

• Active RN licensure required.
• Bachelor’s Degree or equivalent directly applicable experience in nursing, healthcare administration or related area is preferred.

Knowledge, Skills, Abilities

• 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.
• Computer proficiency in Microsoft Office applications and other software programs preferred.
• 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.
• Demonstrated expertise in managing differing customer needs.
• Ability to participate as a team member fostering collaborative decision-making among leadership, committees, teams or work groups of diverse composition.

Experience

• 5 years of clinical experience required.
• 3 years of utilization review experience required.
• Previous workload management experience preferred.

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.

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