Tennessee Licensed Clinical Review ManagerVirtualVocations • Worcester, Massachusetts, United States
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Tennessee Licensed Clinical Review Manager
VirtualVocations • Worcester, Massachusetts, United States
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A company is looking for a Clinical Review Manager to oversee medical reviews for utilization management.
Key Responsibilities
Initiate referrals for appropriate coordination of care
Assist in comprehensive provider and member appeals, including denial interpretation and retrospective claim reviews
Collaborate with the Medical Director and non-clinical staff as needed
Required Qualifications
Active Registered Nurse (RN) license in Tennessee or a participating state
Minimum of 3 years of clinical experience
Proficiency in Microsoft Office applications
Working knowledge of URAC, NCQA, and CMS accreditations
Ability to work independently and manage multiple projects
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Review Manager • Worcester, Massachusetts, United States
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