Remote Clinical Review Nurse - Denials & UM Improvement

Accede Solutions Inc. is hiring a Remote Clinical Review Nurse (Concurrent Review) for a 12-month contract. The role focuses on NCQA-aligned clinical reviews and drafting correspondence letters related to denial determinations for Medicaid products in IL and MI.

You will collaborate with the correspondence team to maintain letter templates, investigate denials through clinical documentation, and coordinate with state, local, and federal agencies to resolve issues in a timely manner.

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