Tennessee Licensed Clinical Review Manager
VirtualVocationsColumbus, Ohio, United States- Full-time
A company is looking for a Clinical Review Manager to oversee clinical information and ensure appropriate care for members.
Key Responsibilities
Research clinical information from providers using CMS guidelines to ensure members receive necessary services
Initiate referrals and coordinate care while consulting with the Medical Director as needed
Assist with administrative reviews and perform comprehensive appeals and claim reviews
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)
Knowledge of URAC, NCQA, and CMS accreditations
Ability to work independently in a fast-paced environment
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Licensed Clinical Manager • Columbus, Ohio, United States