Arizona Licensed Clinical Review Nurse

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