RN 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 accordance with NCQA standards
• Investigates denials and provides supplemental information to resolve claims
• Maintains documentation and coordinates training within the utilization management team

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience
• LPN or RN license required based on specific state regulations
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred