Florida Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Draft and review correspondence letters in compliance with NCQA standards
• Investigate denials and audit clinical documentation to resolve claims
• Provide education and feedback to improve clinical processes and monitor denial trends

Required Qualifications, Training, and Education

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 4 - 6 years of related experience
• Active LPN licensure or compact RN/LPN credential required
• Expertise in Medicare and Medicaid regulations preferred
• Knowledge of utilization management processes preferred