TX 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 compliance with NCQA standards
• Investigates denial claims through comprehensive review of clinical documentation and guidelines
• Coordinates with interdepartmental teams to provide training and feedback for process improvements

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 2 - 4 years of related experience
• Registered Nurse license strongly preferred; LPN licensure required
• Knowledge of Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred