Tennessee Licensed Clinical Review Manager
VirtualVocationsOlympia, Washington, United States- Full-time
A company is looking for a Clinical Review Manager.
Key Responsibilities
Research clinical information from providers using CMS guidelines to ensure appropriate services for members
Initiate referrals for care coordination and consult with the Medical Director as needed
Assist in administrative reviews and perform comprehensive appeals and reviews utilizing clinical judgment
Required Qualifications
Active Registered Nurse (RN) license in Tennessee or a participating Nurse Licensure Compact state
Minimum of 3 years of clinical experience
Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint)
Working knowledge of URAC, NCQA, and CMS accreditations
Ability to work independently and manage multiple projects in a fast-paced environment
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Review Manager • Olympia, Washington, United States