New York Licensed Quality Review Nurse

Job Summary

A company is looking for a Quality Review Nurse.

Key Responsibilities

• Serve as a clinical resource to the Utilization Management Team
• Provide quality clinical review and edits of denial letters to ensure compliance with NCQA requirements
• Apply medical criteria and payer guidelines when reviewing clinical documentation for medical necessity

Required Qualifications

• Graduate of an accredited Practical Nursing program required
• 3+ years of related experience in utilization management required
• 3+ years of clinical experience in acute care required
• Proficiency in Microsoft Office suite required
• Active, unrestricted LPN or LVN license in state of residence required