Job Summary
A company is looking for a Senior Clinical Review Nurse - Correspondence.
Key Responsibilities
- Drafts and audits correspondence letters to ensure compliance with NCQA standards
- Conducts clinical reviews and investigates denial claims through comprehensive documentation analysis
- Provides education and feedback to teams and leadership to enhance clinical processes and resolve issues
Required Qualifications
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
- 4 - 6 years of related experience
- RN or LPN State Licensure required
- Expertise in Medicare and Medicaid regulations preferred
- Knowledge of utilization management processes preferred
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