Tennessee Licensed Clinical Review Manager
Job Summary
A company is looking for a Clinical Review Manager.
Key Responsibilities
- Review clinical documentation for inpatient admissions and specialty services
- Apply standardized clinical guidelines to support utilization management decisions
- Identify barriers to care and connect members with appropriate resources
Required Qualifications
- Active Registered Nurse (RN) license in Tennessee or participating Nurse Licensure Compact state
- Minimum of three years of clinical nursing experience
- Inpatient hospital experience with knowledge of acute care workflows
- Proficient in Microsoft Office applications
- Experience with URAC, NCQA, and CMS accreditations
COMPLETE JOB DESCRIPTION
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