Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Nurse - Correspondence.

Key Responsibilities

• Drafts correspondence letters based on clinical review outcomes in compliance with NCQA standards
• Investigates denial claims by reviewing clinical documentation and provides supplemental information for resolution
• Coordinates with interdepartmental teams to identify training needs and provides feedback to improve clinical processes

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience
• LPN - Licensed Practical Nurse - State Licensure required; RN license for Superior Plan
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred