NY State Licensed Clinical Reviewer
Company: VirtualVocations
Location: Vista
Posted on: May 20, 2025
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Job Description:
A company is looking for a Clinical Review Clinician -
Appeals.
Key Responsibilities
Performs clinical reviews to resolve and process appeals by
analyzing medical records and clinical data
Ensures timely review and response to appeals in compliance with
State, Federal, and NCQA standards
Communicates with members, providers, and other departments
regarding appeal requests and generates resolution reports
Required Qualifications
Graduate from an Accredited School of Nursing or Bachelor's degree
in Nursing
2 - 4 years of related experience
Knowledge of NCQA, Medicare, and Medicaid regulations preferred
RN or LPN preferred; NY State License required
Relevant licensure such as LCSW, LMHC, LPC, LMFT, or Licensed
Psychologist required
Keywords: VirtualVocations, Cathedral City , NY State Licensed Clinical Reviewer, Healthcare , Vista, California
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