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Clinical Correspondence Review Nurse Remote in New York
Job DescriptionJob SummaryThe Clinical Correspondence Review Nurse is responsible for performing quality reviews of written clinical determination letters to members and providers to ensure clinical determination letters adheres to prescribed Federal laws, CMS and Medicaid regulatory guidelines or requirements, and NCQA accreditation standards, for assigned Medicare, Medicaid or Marketplace programs. Knowledge/Skills/Abilities Conducts quality review of the clinical determination letters generated for members, providers and facilities to ensure regulatory and accreditation standards (as applicable) are met. Assist in the development of clinical adverse rationale templates in support of federal health literacy stan


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