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TX Licensed 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 denial claims through comprehensive review of clinical documentation and guidelines Coordinates with interdepartmental teams to provide training and 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 Registered Nurse license strongly preferred; LPN licensure required Knowledge of Medicare and Medicaid regulations preferred Knowledge of utilization management processes preferred
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 denial claims through comprehensive review of clinical documentation and guidelines
Coordinates with interdepartmental teams to provide training and 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
Registered Nurse license strongly preferred; LPN licensure required
Knowledge of Medicare and Medicaid regulations preferred
Knowledge of utilization management processes preferred