Clinical Review Nurse - Correspondence - Remote

Overview

This position involves drafting correspondence letters based on clinical review outcomes, ensuring compliance with NCQA standards, and collaborating with management to enhance clinical processes.

In Short

• Draft correspondence letters based on review outcomes.
• Work in accordance with NCQA standards.
• Perform clinical reviews of outcomes.
• Create and edit denial letters.
• Investigate denials and provide supplemental information.
• Coordinate with interdepartmental teams.
• Provide feedback to improve clinical processes.
• Maintain logs of actions and decisions.
• Assist with issues related to correspondence with agencies.
• Comply with all policies and standards.

Requirements

• 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.
• State Licensure as a Licensed Practical Nurse (LPN) required.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules.