Compact Licensed Clinical Reviewer

A company is looking for a Clinical Review Clinician - Appeals. Key Responsibilities Perform clinical reviews to resolve and process appeals by analyzing medical records and clinical data Determine medical necessity for services in accordance with policies and NCQA standards Ensure compliance with relevant regulations and guidelines Required Qualifications, Training, and Education Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience preferred Knowledge of NCQA, Medicare, and Medicaid regulations preferred State licensure as an LPN, LVN, RN, or other specified clinical licenses required Utilization management processes knowledge preferred

Feb 15, 2025 - 01:00

A company is looking for a Clinical Review Clinician - Appeals. Key Responsibilities Perform clinical reviews to resolve and process appeals by analyzing medical records and clinical data Determine medical necessity for services in accordance with policies and NCQA standards Ensure compliance with relevant regulations and guidelines Required Qualifications, Training, and Education Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience preferred Knowledge of NCQA, Medicare, and Medicaid regulations preferred State licensure as an LPN, LVN, RN, or other specified clinical licenses required Utilization management processes knowledge preferred