Compact Licensed Clinical Reviewer
Company: VirtualVocations
Location: Nashville
Posted on: February 15, 2025
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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
Determine medical necessity for services in accordance with
policies and NCQA standards
Ensure compliance with relevant regulations and guidelines
Required Qualifications, Training, and Education
Graduate from an Accredited School of Nursing or Bachelor's degree
in Nursing
2 - 4 years of related experience preferred
Knowledge of NCQA, Medicare, and Medicaid regulations preferred
State licensure as an LPN, LVN, RN, or other specified clinical
licenses required
Utilization management processes knowledge preferred
Keywords: VirtualVocations, Nashville , Compact Licensed Clinical Reviewer, Healthcare , Nashville, Tennessee
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