Clinical Review & Correspondence RN
C
Cohere HealthHealth Plan
United States, 8am-8pm ESTFull-TimeMiddle
Salary31 - 35 USD per hour
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Job Details
- Experience
- Minimum of 3 years of clinical experience
- Required Skills
- Google Workspace
Requirements
- Registered Nurse with active, unencumbered license in the state of residence
- Minimum 3 years of clinical experience
- Utilization Management experience
- Experience developing member and provider correspondence within a health plan
- Bachelor’s degree in Nursing
- Knowledge of NCQA and CMS standards
- Proficiency in using a Mac
- Experience with G Suite applications
Responsibilities
- Consult with Medical Directors on clinical determinations and medical necessity decisions
- Prepare clear and compliant member and provider communications
- Ensure application of regulatory requirements to clinical determinations
- Support verbal notification workflows
- Document clinical information completely and accurately
- Meet productivity, quality, and turnaround time expectations
- Maintain understanding of accreditation and regulatory compliance standards
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