Job Summary
A company is looking for a Clinical Review Nurse - Correspondence.
Key Responsibilities
- Drafts correspondence letters based on clinical review outcomes in accordance with NCQA standards
- Investigates denials and provides supplemental information to resolve claims
- Coordinates with interdepartmental teams to identify training needs and improve clinical processes
Required Qualifications
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
- 2 - 4 years of related experience
- LPN - Licensed Practical Nurse - State Licensure required
- Knowledge of Medicare and Medicaid regulations preferred
- Knowledge of utilization management processes preferred
Comments