Clinical Review & Correspondence Nurse

Role Responsibilities:

• Consult with Medical Directors on clinical determinations and medical necessity decisions.
• Prepare clear, compliant member and provider communications.
• Document clinical information accurately and timely.

Qualifications:

• Active LPN license and minimum 3 years of clinical experience.
• Utilization management experience and knowledge of NCQA and CMS standards.
• Proficiency in using a Mac and G suite applications.

Compensation & Perks:

• Fully remote with 23 days PTO, 14 weeks paid parental leave.
• Medical, dental, vision, life, disability, 401K match, and pet insurance.
• Hourly pay range $31-$35 based on experience and skills.