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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