State Licensed Clinical Review Clinician
Company: VirtualVocations
Location: Brownsville
Posted on: January 21, 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
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
Keywords: VirtualVocations, Edinburg , State Licensed Clinical Review Clinician, Healthcare , Brownsville, Texas
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