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Clinical Review Nurse
A company is looking for a Clinical Review Nurse - Correspondence. Key Responsibilities Drafts correspondence letters based on clinical review outcomes in compliance with NCQA standards Investigates denials and creates/edit denial letters while collaborating with the correspondence team 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 2 - 4 years of related experience Knowledge of Medicare and Medicaid regulations preferred Knowledge of utilization management processes preferred Ability to comply with all policies and standards
A company is looking for a Clinical Review Nurse - Correspondence.
Key Responsibilities
Drafts correspondence letters based on clinical review outcomes in compliance with NCQA standards
Investigates denials and creates/edit denial letters while collaborating with the correspondence team
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
2 - 4 years of related experience
Knowledge of Medicare and Medicaid regulations preferred
Knowledge of utilization management processes preferred
Ability to comply with all policies and standards