Compact RN Clinical Review Nurse

A company is looking for a Clinical Review Nurse - Correspondence. Key Responsibilities Drafts correspondence letters based on clinical review outcomes in line with NCQA standards Investigates denial claims through comprehensive review of clinical documentation and provides supplemental information Coordinates with interdepartmental teams to identify training needs and provides feedback to improve clinical processes 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 Compact RN license required

Apr 8, 2025 - 22:35

A company is looking for a Clinical Review Nurse - Correspondence. Key Responsibilities Drafts correspondence letters based on clinical review outcomes in line with NCQA standards Investigates denial claims through comprehensive review of clinical documentation and provides supplemental information Coordinates with interdepartmental teams to identify training needs and provides feedback to improve clinical processes 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 Compact RN license required