Texas Licensed Clinical Review RN - Memphis Tennessee

Company: VirtualVocations
Location: Memphis, Tennessee
Posted On: 01/28/2025

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 More...

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