NY State Licensed Clinical Reviewer
A company is looking for a Clinical Review Clinician - Appeals. 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 compliance with State, Federal, and NCQA standards Communicates with members, providers, and other departments regarding appeal requests and generates resolution reports 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 RN or LPN preferred; NY State License required Relevant licensure such as LCSW, LMHC, LPC, LMFT, or Licensed Psychologist required
A company is looking for a Clinical Review Clinician - Appeals.
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 compliance with State, Federal, and NCQA standards
Communicates with members, providers, and other departments regarding appeal requests and generates resolution reports
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
RN or LPN preferred; NY State License required
Relevant licensure such as LCSW, LMHC, LPC, LMFT, or Licensed Psychologist required
