Qureos Mentor

Acentra Health

<div>Company Overview:
<div>
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.</div><div></div><div><br>
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 &ndash; 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.</div>
Job Summary and Responsibilities:
<p><b>
Acentra Health is looking for a Review Assistant to join our growing team.</b></p><div><b><br>
Job Summary:</b></div><p></p><p><br>
The Review Assistant role is pivotal in streamlining the clinical review process by meticulously preparing prior authorization cases. This individual will uphold a comprehensive understanding of internal policies, procedures, and services, ensuring adherence to organizational standards.</p><p></p><p><b><br>
Shift Information: This position requires availability to work between 8:45 a.m. and 8:15 p.m. EST, Monday through Friday, as well as 9:45 a.m. to 7:15 p.m. EST on weekends and holidays.</b></p><div><b><br>
Responsibilities:</b></div><ul><li>
Provide primary non-clinical program support by encompassing provider training, customer service, call triaging, authorization preparation, data entry, and the development and tracking of functions for members and providers.</li><li>
Offer non-clinical support to other programs as needed, ensuring flexibility and adaptability in meeting organizational requirements.</li><li>
Review patient records for completeness against submission requirements, identifying cases requiring additional non-clinical information.</li><li>
Process and document case discharges with precision and timeliness.</li><li>
Ensure accurate and prompt submission of all administrative-related documents to relevant parties.</li><li>
Act as a liaison with internal and external customers, fostering positive and professional relationships to facilitate an effective review process.</li><li>
Attend training and scheduled meetings, maintaining up-to-date information for case preparation.</li><li>
Uphold medical records confidentiality through proper use of computer passwords and secured files, adhering to HIPAA policies.</li><li>
Answer calls and demonstrate proper telephone etiquette and communication skills in alignment with Acentra Health's policies, procedures, and guidelines.</li><li>
Cross-train to perform duties of other contracts within the Acentra Health network, contributing to a flexible workforce to meet client/consumer needs.</li><li>
Fulfill other assigned duties to meet contract deliverables and organizational requirements.</li><li>
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.</li></ul><p><i>
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.</i></p>
Qualifications:
<p><b>
Required Qualifications</b></p><ul><li>
High school diploma or GED equivalent.</li><li>
1-2 years of experience in administrative or records management.</li><li>
2-3 years in an administrative support or customer service position and be familiar with healthcare.</li></ul><p><b>
Preferred Qualifications</b></p><ul><li>
Comprehensive knowledge of office environments and business processes.</li><li>
Associate degree preferred and/or equivalent work experience related to medical, behavioral, or social/support settings.</li><li>
Understanding of a customer service approach tailored for medical provider stakeholders.</li><li>
Familiarity with government structures and related programs is advantageous.</li><li>
Excellent communication skills.</li><li>
Ability to multitask, prioritize, and provide service to a diverse range of customers.</li><li>
Experience in development and project activities.</li><li>
Experience in staff and provider training, with preferred public speaking skills.</li><li>
A proactive approach to continually assess office functions and report potential issues to the Director.</li><li>
Capability to track provider issues and report them appropriately.</li><li>
Willingness to learn the Atrezzo application and assist customers in resolving technical issues related to the submission of Health Homes authorization requests.</li><li>
Proficiency in Microsoft Office applications and Excel, ensuring efficient utilization of essential software tools.</li></ul><div><b>
Why us?</b></div><div></div><div><br>
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.</div><div></div><div><b><br>
We do this through our people.</b></div><div></div><div><br>
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.</div><div></div><div><b><br>
Benefits</b></div><div></div><div><br>
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.</div><div></div><div><b><br>
Compensation</b></div><div></div><div><br>
The pay range for this position is listed below.</div><div></div><div><br>
&ldquo;Based on our compensation philosophy, an applicant&rsquo;s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.&rdquo;</div><div></div><div><b><br>
Thank You!</b></div><div></div><div><br>
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!</div><div></div><div><br>
~ The Acentra Health Talent Acquisition Team</div><div></div><div><br>
Visit us at https://careers.acentra.com/jobs</div><div></div><div><b><br>
EEO AA M/F/Vet/Disability</b></div><div></div><div><br>
Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.</div>
Pay Range: USD $17.46 - USD $17.75 /Yr.</div>

Review Assistant - SCA (Remote)

<div>Company Overview:
<div>
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.</div><div></div><div><br>
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 &ndash; 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.</div>
Job Summary and Responsibilities:
<p><b>
Acentra health is looking for a Dental Medical Reviewer (DDS/DMD) - PRN (Remote U.S. within Alaska Time Zone Hours)</b></p><p></p><p><b><br>
Job </b><b>Summary:</b></p><ul><li>
The Dental Medical Reviewer Doctor of Dental Surgery (DDS) <b>OR </b>Doctor of Medicine in Dentistry (DMD) - PRN will oversee Utilization Management (UM) activities to include peer review, utilization review, fair hearings and appeals, and other clinical consultations related to the applicable contract and will support the Dental UM contract.
</li></ul><p><b>Responsibilities:</b></p><ul><li>
Responsible for the clinical oversight of the Dental Utilization Management program.</li><li>
Collaborate with the State Medical Director or Program Director on case consultations as needed.</li><li>
Must be available a minimum of four (4) hours per week.</li><li>
Participate in the client's quarterly and ad-hoc contract meetings.</li><li>
Review safety, sentinel, and Quality of Care events and provide detailed feedback and recommendations as per organization and policy.</li><li>
Complete all secondary-level Dental Utilization Management reviews.</li><li>
Develop and complete an annual review of clinical medical necessity criteria.</li><li>
Participate in appeal hearings as needed.</li><li>
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.</li></ul><p><b><i>
The above list of responsibilities 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.</i></b></p><p><br>
</p><p><b>PLEASE NOTE</b><b>:</b></p><p></p><p><b><i><br>
* This role is contingent upon being awarded a contract. Start dates and final offers are contingent upon the contract award and final contract start dates. *</i></b></p><p></p><p><b><i><br>
* </i></b><b><i>Work Hours: Must be available for a minimum of four (4) hours per week during Alaska Time Zone business hours. *</i></b></p>
Qualifications:
<div><b>
Required Qualifications/Experience:</b></div><ul><li><b>
Must be available to work business hours as defined by contract within the Alaska Time Zone.</b><ul><li><b>
AND must be available for a minimum of four (4) hours per week.</b></li></ul></li><li>
Doctor of Dental Surgery (DDS) <b>OR </b>Doctor of Medicine in Dentistry (DMD) degree from an accredited dental school.</li><li>
D.D.S. or D.M.D. state license in good standing (licensed in the state practicing from at a minimum).</li><li>
5+ years of experience in Utilization Management (UM), Service Authorization (SA), or other clinical review processes for Medicaid or another large healthcare payer.</li></ul><p><b>
Preferred Qualifications/Experience:</b></p><ul><li>
Residency within Alaska, Pacific, <b>OR</b> Mountain Time Zone.</li><li>
10+ years of clinical practice.</li><li>
5+ years of experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues.</li><li>
2+ years of experience as a Medical Director in a managed care company.</li></ul><p>
#LI-SD1</p><p></p><div><b><br>
Why us?</b></div><div></div><div><br>
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.</div><div></div><div><b><br>
We do this through our people.</b></div><div></div><div><br>
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.</div><div></div><div><b><br>
Thank You!</b></div><div></div><div><br>
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!</div><div></div><div><br>
~ The Acentra Health Talent Acquisition Team</div><div></div><div><br>
Visit us at Acentra Health</div><div></div><div><b><br>
EEO AA M/F/Vet/Disability</b></div><div></div><div><br>
Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.</div><div></div><div><b><br>
Compensation</b></div><div></div><div><br>
The pay for this position is listed below.</div><div></div><div><b><i><br>
&quot;Based on our compensation philosophy, an applicant&rsquo;s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.&quot;</i></b></div>
Pay Range: USD $76.92 - USD $105.00 /Hr.</div>

Dental Medical Reviewer (DDS/DMD) - PRN (Remote U.S. within Alaska Time Zone Hours)

<div>Company Overview:
<div>
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.</div><div></div><div><br>
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 &ndash; 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.</div>
Job Summary and Responsibilities:
<p><b>
Acentra seeks a Clinical Reviewer to join our growing team.</b></p><p></p><p><b><br>
Job Summary:</b></p><p></p><p><br>
The purpose of this position is to review medical records against appropriate criteria in conjunction with contract requirements to determine medical appropriateness.</p><div></div><div><b><i><br>
**Shift hours will be 8:00am to 4:30pm EST including weekend and holiday rotations**</i></b></div><div></div><div><b><br>
Job Responsibilities:</b></div><ul><li>
Assures accuracy and timeliness of all applicable review type cases within contract requirements.</li><li>
Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department.</li><li>
In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.</li><li>
Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.</li><li>
Functions as providers&rsquo; liaison and contact/resource person for provider customer service issues and problem resolution.</li><li>
Performs all applicable review types as workload indicates.</li><li>
Fosters 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.</li><li>
Attends training and scheduled meetings and for maintenance and use of current/updated information for review.</li><li>
Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs.</li><li>
Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules</li></ul><p></p><p><i><br>
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.</i>
</p>Qualifications:
<p><b>
Required Qualifications/Experience:</b></p><ul><li>
Active unrestricted RN or, or other applicable State and/or Compact State clinical license per contract requirements.</li><li>
Requires a Bachelor&rsquo;s Degree from an accredited college or university in a related field.</li><li>
Must be able to work a schedule of 8:00am to 4:30pm EST including a weekend and holiday rotation.</li></ul><p><b>
Preferred Qualifications/Experience:</b></p><ul><li>
Knowledge of the organization of medical records, medical terminology, and disease process required.</li><li>
Strong clinical assessment and critical thinking skills required. Medical record abstracting skills required.</li><li>
Requires excellent written and verbal communication skills.</li><li>
Medical record abstracting skills required.</li></ul><div><b>
Why us?</b></div><div></div><div><br>
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.</div><div></div><div><b><br>
We do this through our people.</b></div><div></div><div><br>
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.</div><div></div><div><b><br>
Benefits</b></div><div></div><div><br>
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.</div><div></div><div><b><br>
Compensation</b></div><div></div><div><br>
The pay range for this position is listed below.</div><div></div><div><br>
&ldquo;Based on our compensation philosophy, an applicant&rsquo;s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.&rdquo;</div><div></div><div><b><br>
Thank You!</b></div><div></div><div><br>
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!</div><div></div><div><br>
~ The Acentra Health Talent Acquisition Team</div><div></div><div><br>
Visit us at https://careers.acentra.com/jobs</div><div></div><div><b><br>
EEO AA M/F/Vet/Disability</b></div><div></div><div><br>
Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.</div>
Pay Range: USD $28.00 - USD $32.00 /Hr.</div>

Clinical Reviewer - RN (SCA - Remote)

Join Acentra Health and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Acentra Health

ABOUT_COMPANY

Review Assistant - SCA (Remote)

Dental Medical Reviewer (DDS/DMD) - PRN (Remote U.S. within Alaska Time Zone Hours)

Clinical Reviewer - RN (SCA - Remote)