State Licensed Clinical Review Clinician
Company: VirtualVocations
Location: Vista
Posted on: May 22, 2025
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Job 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 accordance with standards
Communicate with members, providers, and other departments
regarding appeal 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 in appeals, denials, and
utilization management
Active nursing license or relevant clinical licensure (LPN, LVN,
RN, LCSW, LMHC, LPC, LMFT, or Licensed Psychologist)
Knowledge of NCQA, Medicare, and Medicaid regulations preferred
Familiarity with utilization management processes preferred
Keywords: VirtualVocations, San Clemente , State Licensed Clinical Review Clinician, Healthcare , Vista, California
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