Licensed Clinical Review Clinician
Job in
Rockford, Winnebago County, Illinois, 61103, USA
Listed on 2026-03-05
Listing for:
Virtual Vocations Inc
Full Time
position Listed on 2026-03-05
Job specializations:
-
Healthcare
Job Description & How to Apply Below
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 accordance with State, Federal, and NCQA standards Communicates with members, providers, and facilities regarding appeals requests and generates appropriate resolution communications
Required Qualifications , Training, and Education 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 State Licensure as an LPN, LVN, RN, LCSW, LMHC, LPC, LMFT, or Licensed Psychologist required Knowledge of utilization management processes preferred
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