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Arizona Licensed Clinical Review Nurse

7/10/2025

Remote

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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