Missouri Licensed Clinical Review NurseVirtualVocations • Sugar Land, Texas, United States
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Missouri Licensed Clinical Review Nurse
VirtualVocations • Sugar Land, Texas, United States
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
A company is looking for a Clinical Review Nurse - Retrospective Review.
Key Responsibilities
Conducts clinical retrospective reviews of medical records to assess the appropriateness of care and services provided
Identifies quality of care issues and consults with senior management and healthcare providers on discrepancies
Maintains compliance with regulatory guidelines by documenting member clinical information in health management systems
Required Qualifications, Training, and Education
Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing
2 - 4 years of related experience in clinical review or utilization management
Knowledge of Medicare and Medicaid regulations preferred
Knowledge of utilization management processes preferred
LPN - Licensed Practical Nurse - State Licensure required
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Clinical Review Nurse • Sugar Land, Texas, United States
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