Missouri Licensed Clinical Review Nurse

Job Summary

A company is looking for a Clinical Review Nurse - Correspondence.

Key Responsibilities

• Drafts and edits denial letters based on clinical review outcomes in line with NCQA standards
• Maintains correspondence letter templates and investigates denials through comprehensive reviews of clinical documentation
• Coordinates with interdepartmental teams and provides feedback to leadership for process improvements

Required Qualifications

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