Texas Licensed Clinical Review Nurse

Job Summary

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

Key Responsibilities

• Oversees clinical review of outcomes and manages correspondence letters in compliance with NCQA standards
• Provides expert guidance on the clinical review process and ensures compliance with State and Federal regulations
• Manages data trends and recommends process improvements to senior management

Required Qualifications

• Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
• 5 - 7 years of related experience
• Expert knowledge of Medicare and Medicaid regulations preferred
• Expert knowledge of utilization management processes preferred
• LPN or RN license required, depending on the state