State Licensed Clinical Review Clinician - Port Saint Lucie Florida

Company: VirtualVocations
Location: Port Saint Lucie, Florida
Posted On: 01/19/2025

A company is looking for a Clinical Review Clinician - Appeals.



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 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
State Licensure as an LPN, LVN, RN, LCSW, LMHC, LPC, LMFT, or Licensed Psychologist required
Experience in utilization management processes preferred More...

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