Licensed Practical Nurse - Remote

Job Summary

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

Key Responsibilities

• Drafts correspondence letters based on clinical review outcomes in line with NCQA standards
• Investigates denials through comprehensive reviews of clinical documentation and provides supplemental information to resolve claims
• Coordinates with interdepartmental teams for training and provides feedback to leadership for process improvements

Required Qualifications, Training, and Education

• Graduate from an accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience in prior authorization, concurrent review, or utilization review
• Knowledge of Medicare and Medicaid regulations preferred
• LPN - Licensed Practical Nurse - State Licensure required