Clinical Review & Correspondence Nurse
New
C
Cohere HealthHealthcare
Location: 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
- LPN with active, unencumbered license in the state of residence.
- Minimum of 3 years of clinical experience.
- Prior Utilization Management experience.
- Knowledge of NCQA and CMS standards and requirements.
- Experience developing member and provider correspondence within a health plan environment.
- Proficiency in using a Mac.
- Experienced with G Suite applications.
- Must have robust internet speeds (above 50 megabytes/second).
- Nursing Certification.
Responsibilities
- Consult with Medical Directors on clinical determinations and medical necessity decisions.
- Prepare clear, accurate, and compliant member and provider communications.
- Apply regulatory requirements governing utilization management to clinical determinations.
- Manage member and provider notification workflows.
- Document clinical information completely, accurately, and in a timely manner.
- Maintain compliance with accreditation and regulatory standards.
- Meet or exceed productivity, quality, and turnaround time expectations.
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