Clinical Review Clinician New York Licensed
Company: VirtualVocations
Location: Pasadena
Posted on: November 19, 2024
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Job Description:
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
Keywords: VirtualVocations, Houston , Clinical Review Clinician New York Licensed, Healthcare , Pasadena, Texas
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