Role Description The RN Coding Specialist supports documentation integrity, coding accuracy, and clinical review of medical records. Why Join Us? - Competitive Compensation: $60.00/hour - Comprehensive Benefits: Comprehensive benefits package - Work Schedule: Full-time, Monday–Friday - Professional Growth: Combine nursing knowledge with coding expertise - Impactful Work: Enhance documentation integrity and coding accuracy Key Responsibilities - Review clinical documentation for accuracy and completeness - Support coders by providing clinical insight and clarification - Assist with audit reviews and quality improvement - Query providers for missing or unclear clinical details - Stay updated on coding and clinical documentation regulations Physical Examination Responsibilities - None or minimal; primarily office-based Qualifications - Active RN license (NY) - CPC, CCS, or clinical coding background - 2+ years clinical experience - Requires both RN licensure and coding certification or experience Skills - Strong clinical judgment - Excellent understanding of medical terminology - Ability to bridge clinical and coding concepts

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Acentra Health is looking for a Physician Medical Reviewer-PRN to join our growing team. Acentra Health is seeking a Physician Medical Claims Reviewer to support independent medical service appeal reviews for priority populations with complex healthcare needs. In this role, you will: - Prepare independent reviews of medical services appeals. - Review records, prepare and submit all reviews in keeping with the Acentra Health contractual due dates. - Critically evaluate the application of guidelines and protocols by managed care organizations, dental benefits manager, and pharmacy benefits manager. - Review relevant peer-reviewed research and evidence-based sources as needed. - Edit Medical Necessity Reviews authored by other reviewers. - Provide expert medical witness testimony for the State in appeals hearings. - Participate in quality assurance activities for medical necessity reviews and hearing outcomes. - Regularly review relevant topics via peer-reviewed articles and evidence-based sources. - Work with medical, nursing, and administrative staff to identify matters needing shared attention. - May primarily work remotely but must be available onsite to the client as contractually required. - Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The 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. Qualifications - Must have Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited institution. - Must possess a current, active, and unrestricted license to practice medicine in the State of California (or be eligible for California licensure). - Demonstrated work experience in Utilization Review within Behavioral Health Services. - Strong working knowledge of quality assurance principles and utilization review processes within a healthcare or managed care environment. - Minimum of 5+ years of professional clinical practice experience as a licensed physician. - Experience working with Medicaid and/or Medi-Cal programs, including knowledge of applicable regulatory guidelines and medical necessity criteria. - Previous experience in managed care, utilization management, or utilization review is required. Requirements - Demonstrated ability to work effectively with individuals from diverse backgrounds and professional disciplines. - Adaptable professional with a collaborative leadership style, strong problem-solving abilities, and a proactive mindset. - Detail-oriented with strong organizational skills, and the ability to prioritize tasks and manage multiple responsibilities while meeting established deadlines. - Excellent written communication skills, with the ability to review and assess clinical determinations within established turnaround times. - Proficient in computer-based applications, including Microsoft Office Suite (Word, Excel, Outlook, and Teams), and other standard business and collaboration tools. Benefits - Access to select Acentra Health benefits and programs. - Participation in the Acentra Health 401(k) Plan with company match. - Access to wellness and employee discount programs. - Employee Assistance Program (EAP) resources. Compensation The compensation for this role is $88.70 hour - $120.00 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.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Acentra Health is looking for a Clinical Reviewer RN - PRN to join our growing team. The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements. Position is remote Required Work Hours: On-call weekends, holidays and evenings - Assures accuracy and timeliness of all applicable review type cases within contract requirements. - Assesses, evaluates, and addresses daily workload and queues; adjusts work schedules daily to meet the workload demands of the department. - In collaboration with Supervisor, responsible for quality monitoring activities. - Maintains current knowledge base related to review processes and clinical practices. - Functions as providers' liaison for customer service issues and problem resolution. - Performs all applicable review types as workload indicates. - Fosters positive and professional relationships with internal and external customers. - Attends training and scheduled meetings for current/updated information. - Cross trains to provide flexible workforce to meet client/customer needs. - Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. 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. Qualifications - Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state License. - A minimum of 2+ years of clinical experience in an acute OR med-surgical environment. - Knowledge of medical records, medical terminology, and disease process organization. - Skilled in reviewing, interpreting, and abstracting data from medical records. - Strong clinical assessment and critical thinking skills. - Excellent verbal and written communication skills. - Must be proficient in Microsoft Office and internet/web navigation. Requirements - Bachelor's Degree from an accredited college or university in a related field. - Knowledge of current National Committee for Quality Assurance (NCQA) standards. - Knowledge of Utilization Review Accreditation Commission (URAC) standards. - Knowledge of Independent Review Organization (IRO). - Knowledge of Medicare (CMS) guidelines. - Experience with Medical Appeals. - Ability to work in a team environment. - Flexibility and strong organizational skills. Benefits - Access to select Acentra Health benefits and programs. - Participation in the Acentra Health 401(k) Plan with company match. - Access to wellness and employee discount programs. - Employee Assistance Program (EAP) resources.

Role Description The Behavioral Health Subject Matter Expert (BH SME) provides specialized clinical and systems-level expertise on Tobacco Use Disorder (TUD) within behavioral health settings, with a focus on integrating evidence-based guidelines into health systems that serve people living with serious mental illness and substance use disorders. The BH SME supports the development of tools, resources, and best practices, and contributes to report writing and grant deliverables for the statewide Center for Health Systems Improvement. Key Responsibilities - Provide subject matter expertise on behavioral health and TUD, including guideline-concordant assessment, diagnosis, and treatment approaches, with attention to priority populations disproportionately affected by commercial tobacco use. - Contribute to the design and refinement of clinical workflows, protocols, and decision-support tools that embed evidence-based TUD treatment into behavioral health care systems, including screening, counseling, medication use, and follow-up. - Advise on best practices for implementing systems-level strategies identified in the PHS Clinical Practice Guideline (screening systems, provider training/resources/feedback, and dedicated staffing) in behavioral health organizations. - Collaborate with QI, program, and data staff to interpret behavioral health system data and identify gaps, barriers, and opportunities to improve TUD treatment delivery and health equity. - Assist with the development of educational materials, training content, and technical assistance tools tailored for behavioral health providers and organizational leaders. - Provide expert input into written reports, proposals, and other contract deliverables, ensuring technical accuracy, alignment with the RFA scope of work, and clear linkage to project outcomes. - Support the identification and dissemination of best practices related to emerging nicotine delivery products and their impact on behavioral health populations, including strategies to counter industry disinformation. - Participate in internal and external meetings, workgroups, and partner convenings as the behavioral health and TUD clinical resource for the project. Qualifications - Education: Advanced clinical degree in psychology, social work, psychiatry, psychiatric nursing, or related behavioral health field (e.g., PhD, PsyD, MD, DO, DNP, LCSW, LMHC, or equivalent). - Experience: - Demonstrated experience working in behavioral health settings serving individuals with serious mental illness and/or substance use disorders, preferably within health systems or community-based organizations. - Experience implementing or advising on evidence-based practices or systems-level interventions in behavioral health or chronic disease care (e.g., tobacco cessation, substance use treatment, or integrated care). - Experience contributing to written reports, proposals, or program deliverables in public health, behavioral health, or health systems projects. - Technical Skills: Familiarity with evidence-based guidelines for treating Tobacco Use Disorder and related clinical practice guidelines for behavioral health populations. - Soft Skills: - Strong subject matter expertise in behavioral health, TUD, and health disparities, including understanding of the needs of populations disproportionately affected by commercial tobacco. - Ability to translate clinical and scientific evidence into practical tools, workflows, and policies for health care organizations. - Excellent written communication skills for contributing to reports, guidance documents, and educational materials. - Strong interpersonal and consultation skills for working with program leads, QI advisors, health system leaders, and front-line providers. - Commitment to health equity, culturally responsive care, and advancement of tobacco-free policies in behavioral health settings. Benefits - Competitive Compensation: $25.00/hour - Work Schedule: Part-time (0.5 FTE) with long-term contract stability (5-year term) - Professional Growth: Shape statewide behavioral health initiatives - Impactful Work: Reduce tobacco-related disparities in vulnerable populations