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California Licensed RN Clinical Reviewer
A company is looking for an RN Clinical Review Clinician - Appeals. Key Responsibilities Performs clinical reviews to resolve and process appeals by analyzing medical records and clinical data Prepares case reviews for Medical Directors and ensures timely processing of appeals in accordance with standards Communicates with various stakeholders regarding appeal requests and collaborates to improve clinical appeals processes Required Qualifications, Training, and Education Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing Minimum of 2 - 4 years of related experience RN California Licensure required Knowledge of NCQA, Medicare, and Medicaid regulations preferred Knowledge of utilization management processes preferred
A company is looking for an RN Clinical Review Clinician - Appeals.
Key Responsibilities
Performs clinical reviews to resolve and process appeals by analyzing medical records and clinical data
Prepares case reviews for Medical Directors and ensures timely processing of appeals in accordance with standards
Communicates with various stakeholders regarding appeal requests and collaborates to improve clinical appeals processes
Required Qualifications, Training, and Education
Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
Minimum of 2 - 4 years of related experience
RN California Licensure required
Knowledge of NCQA, Medicare, and Medicaid regulations preferred
Knowledge of utilization management processes preferred