Clinical Review Clinician New York Licensed - Pasadena Texas

Company: VirtualVocations
Location: Pasadena, Texas
Posted On: 11/20/2024

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 accordance with standards
Communicate with members, providers, and other departments regarding appeal requests and generate resolution communications

Required Qualifications, Training, and Education

Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2 - 4 years of related experience
Must have a New York State clinical license (LPN, LVN, RN, LCSW, LMHC, LPC, LMFT, or Licensed Psychologist)
Knowledge of NCQA, Medicare and Medicaid regulations preferred
Knowledge of utilization management processes preferred More...

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