North Carolina Licensed Clinical Reviewer

Job Summary

A company is looking for a Clinical Reviewer-PRN.

Key Responsibilities

• Review medical records against appropriate criteria and contract requirements
• Draft denial narratives and letters for adverse determinations
• Maintain quality monitoring activities and collaborate with team members to meet workload demands

Required Qualifications

• Active unrestricted RN license
• 1+ years of experience in conducting plan of care (POC) reviews
• Knowledge of medical records, medical terminology, and disease processes
• Strong understanding of NC Medicaid policies and regulations
• Strong clinical assessment and critical thinking skills