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California RN Appeals Clinician
Location:
Dorchester, MA
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 communications Required Qualifications Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing 2 - 4 years of related experience RN license required for Health Net of California Knowledge of NCQA, Medicare, and Medicaid regulations preferred Knowledge of utilization management processes preferred
Company:
Virtualvocations
Posted:
November 6 on TopUSAJobs
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