Texas Licensed Clinical Review Nurse

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