Clinical Care Coordinator - RN (Remote within Florida)

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. 

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 daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – 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. 

Acentra is looking for a Clinical Care Coordinator RN (Remote within Florida) to join our growing team.

Job Summary:

The Clinical Care Coordinator provides care coordination outreach activities to support the care management program. They will:

• Act as a patient advocate by providing immediate advocacy between the patient and providers to ensure the patient has what is needed.
• Utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and QA standards.
• Ensure day-to-day processes follow NCQA, URAC, and other regulatory standards.

** This is a full-time, non-exempt (hourly) direct hire role with Benefits. **

** To qualify for this role, you must reside and work remotely from the state of Florida. **

** Work Hours for this role are Monday through Friday, 8:00 AM to 5:00 PM Eastern. **

** Occasional travel up to 5% annually within the State of Florida may be required for this role. **

Job Responsibilities:

• Ensure the responsible delivery of comprehensive services to enrollees.
• Conduct general assessments for supervisor/lead interpretation/evaluation and assignment to case manager/health coach based on results.
• Plan and participate in interdisciplinary team meetings for collaborative assessment and coordination planning to ensure quality care.
• Proactively engage in the delivery of quality management program activities that are the direct responsibility of the Health Services team.
• Assist in the achievement and ongoing maintenance of accreditations for defined programs.
• Provide education and resources to beneficiaries/families/providers.
• Review and interpret patient records and compare against criteria to determine medical necessity and appropriateness of care; determine if the medical record documentation supports the need for services.
• Determine approval or initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for the denial is described in sufficient detail in correspondence.
• Abstract review of related data/information accurately and timely on appropriate review tools by the proper means.
• Accurate and timely submission of all administrative and review-related documents to appropriate parties.
• Perform ongoing reassessment of the review process to offer opportunities for improvement and/or change.
• Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Responsible for attending training and scheduled meetings and maintaining and using current/updated information for review.
• Maintain medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies.
• Utilize proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures, and guidelines.
• Actively cross-train to perform duties of other contracts within the Acentra Health network to provide a flexible workforce to meet client/consumer needs.
• Other duties as assigned.

The above list of accountabilities is not intended to be all-inclusive. It may be expanded to include other education and experience-related duties that management may deem necessary from time to time.

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 a vital partner to ensure better healthcare and improve health outcomes. 

We do this through our people. 

You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement you need to achieve the finest work of your career. 

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 chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply for future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers

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.

Requirements

Required Qualifications/Experience:

• Active unrestricted Registered Nurse (RN) License or other applicable State and/or Compact State clinical license per contract requirements AND 2+ years of pediatric experience.
• Graduate with a diploma from an accredited Associate, Bachelor’s, or Master’s Degree Program.
• Knowledge of principles, ethics, and precepts of care management service delivery.
• Knowledge of customer service principles.
• Strong telephonic interviewing skills.
• Strong prioritization and organizational skills.
• Ability to receive verbal and written feedback in a professional manner and implement performance and productivity improvements as needed.
• Knowledge of the organization of medical records, medical terminology, and disease processes.
• Strong clinical assessment and critical thinking skills.
• Excellent verbal and written communication skills.
• Ability to work in a team environment.
• Ability to be flexible.
• Strong computer skills (e.g., care management applications, Internet/Web, Microsoft Office [Word, Excel]).
• A clean, current MVR (Motor Vehicle Record) and reliable transportation to travel in the state of Florida.

Preferred Qualifications/Experience:

• Medical record abstracting skills.
• Knowledge and familiarity with public sector health coverage systems (e.g., Medicare/Medicaid).
• Knowledge of current Utilization Review Accreditation Committee (URAC) standards.
• Knowledge of current National Committee for Quality Assurance (NCQA) standards.

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Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide 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.  

Compensation 

The pay range for this position is $34.00 to 36.72 hourly.

“Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”