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Licensed Clinical Review Clinician
A company is looking for a Clinical Review Clinician - Appeals - Behavioral Health. Key Responsibilities Performs clinical reviews to resolve and process appeals by analyzing medical records and clinical data Ensures timely review and response to appeals in accordance with State, Federal, and NCQA standards Communicates with members, providers, and other departments regarding appeals requests Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience Knowledge of NCQA, Medicare, and Medicaid regulations preferred State Licensure as LPN, LVN, RN, LCSW, LMHC, LPC, LMFT, or Licensed Psychologist required For Health Net of California: RN license required
A company is looking for a Clinical Review Clinician - Appeals - Behavioral Health.
Key Responsibilities
Performs clinical reviews to resolve and process appeals by analyzing medical records and clinical data
Ensures timely review and response to appeals in accordance with State, Federal, and NCQA standards
Communicates with members, providers, and other departments regarding appeals requests
Required Qualifications
Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2 - 4 years of related experience
Knowledge of NCQA, Medicare, and Medicaid regulations preferred
State Licensure as LPN, LVN, RN, LCSW, LMHC, LPC, LMFT, or Licensed Psychologist required
For Health Net of California: RN license required
