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.Position OverviewThe Utilization Management Review Assistant plays a pivotal role in enhancing the efficiency and accuracy of the Treatment Authorization Request (TAR) form completion process, directly contributing to the streamlining of the review workflow. This position is critical in managing the documentation of case information within the Electronic Medical Records (EMR) system, ensuring continuous monitoring and meticulous tracking of necessary documents. The invidual is expected to maintain an in-depth understanding of internal policies, procedures, and services, spanning both departmental and operational spectrums, to uphold the highest standards of productivity and quality. These efforts are essential for meeting or exceeding the stipulated contract deliverables. Additionally, the Review Assistant is responsible for the preparation of all pertinent documents and reports to effectively support the concurrent review process.Job Responsibilities
Conduct thorough reviews of patient records, ensuring alignment with submission criteria to confirm the presence of all necessary information for case processing. Identify instances requiring additional non-clinical details.
Guarantee the efficient and precise completion of Treatment Authorization Request (TAR) forms.
Ensure the accurate and prompt submission of all administrative documents to the relevant parties.
Cultivate positive and professional relationships, serving as a key liaison between internal and external stakeholders to promote effective collaboration and team cohesion, thereby streamlining the review process.
Commit to professional development by participating in training sessions and meetings, as well as staying informed on the latest information and practices for meticulous case preparation.
Engage in cross-training to acquire competencies in handling responsibilities across various contracts within the Kepro network, contributing to a versatile workforce that adapts to the evolving needs of clients and consumers.
Execute additional tasks as required, demonstrating flexibility and a commitment to the team's success.
Required Qualifications, Skills, Knolwedge and Experience
Minimum of 2 years of experience in the healthcare or managed healthcare industry is required.
3 - 5 years of experience in administrative roles or records management preferred.
A Bachelor’s Degree is highly desirable.
An Associate Degree or equivalent professional experience in medical, behavioral, or social/supportive settings is mandatory.
Previous involvement in Concurrent Review and Utilization Management (UM) processes is advantageous.
Quality Improvement (QI) and Utilization Review experience is also valuable.
Proficient in conducting reviews of records, claims, or requests within the healthcare sector.
In-depth understanding of HIPAA, alongside state and federal regulations relevant to behavioral health.
Familiarity with Medi-Cal billing procedures.
Experience with medical terminology and/or Treatment Authorization Request (TAR) processes is beneficial.
Competence in using software tools applicable to healthcare or insurance settings.
Skilled in interpreting complex documentation and organizing case information for clear and precise presentation.
Proven ability to manage tasks effectively in a dynamic, fast-paced environment.
Strong verbal and written communication skills are essential.
Strong analytical and critical thinking skills are a must.
Proficiency in computer applications, including Kofax PDF, Microsoft Office suite, and specialized proprietary software.
Demonstrates flexibility and superior organizational capabilities.
Capable of thriving in a remote team setting.
Exceptional attention to detail is crucial.
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. CompensationThe compensation for this role is $22.00 to $28.00 per hour. Based on our compensation program, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level. Thank you.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.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
