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Texas Licensed Clinical Review Nurse

7/9/2025

No location specified

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 denial claims through review of clinical documentation and provides supplemental information to resolve issues
  • Coordinates with interdepartmental teams to identify training needs and provides feedback for process improvements
Required Qualifications
  • Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
  • 4 - 6 years of related experience
  • Active LPN license required
  • Expertise in Medicare and Medicaid regulations preferred
  • Expertise in utilization management processes preferred

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