Tennessee Licensed Clinical Review Manager

Job Summary

A company is looking for a Clinical Review Manager.

Key Responsibilities

• Initiate referrals to ensure appropriate coordination of care
• Assist non-clinical staff in the performance of administrative reviews
• Perform comprehensive provider and member appeals, denial interpretation, and utilization management pre-certifications

Required Qualifications

• Active Registered Nurse (RN) license in Tennessee or a participating Nurse Licensure Compact state
• At least 3 years of clinical experience required
• Proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint)
• Working knowledge of URAC, NCQA, and CMS accreditations
• Ability to work independently and manage multiple projects and priorities