Licensed Clinical Letter Writer

Job Summary

A company is looking for a Clinical Letter Writer with UM & Specialty Experience.

Key Responsibilities

• Review adverse determinations against criteria and medical policies
• Create adverse determination notifications that meet accreditation, State, and Federal criteria
• Collaborate with internal and external staff to ensure clear communication of decisions

Required Qualifications

• Licensed registered nurse or LVN/LPN (current and unrestricted)
• Minimum of three years of direct clinical patient care
• Minimum one year of experience with Utilization Review (UM) in a managed care environment
• Cardiology and Oncology healthcare experience/knowledge
• Experience with clinical decision-making criteria sets (e.g., Milliman, InterQual)