Texas Licensed Clinical Review RN
Company: VirtualVocations
Location: Saint Charles
Posted on: January 21, 2025
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Job Description:
A company is looking for a Clinical Review Clinician - Appeals
(RN).
Key Responsibilities
Perform clinical reviews to resolve and process appeals by
analyzing medical records and clinical data
Prepare case reviews for Medical Directors and ensure timely
processing of appeals in compliance with standards
Communicate with members, providers, and other departments
regarding appeals requests and generate resolution
communications
Required Qualifications
Graduate from an Accredited School of Nursing or Bachelor's degree
in Nursing
2 - 4 years of related experience
RN - Registered Nurse - State Licensure and/or Compact State
Licensure and/or Texas License required
Knowledge of NCQA, Medicare, and Medicaid regulations preferred
Knowledge of utilization management processes preferred
Keywords: VirtualVocations, Jefferson City , Texas Licensed Clinical Review RN, Healthcare , Saint Charles, Missouri
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