The Nurse Specialist (LVN, LPN, RN) is directly accountable to the Manager, Medical Services for the preparation and review of all special clinical files to ensure accuracy and compliance. They are expected to function with minimal direct supervision but guidance will be available. The candidate must possess solid writing skills as they will be responsible for making all edits and providing written clinical explanations to clients as necessary. The Individual will collaborate with the Medical Director and the Medical Reviewers/MD for clarity regarding medical terminology, consistency of CPT Codes, and guidelines. Other aspects of the job are special projects involving claims review and medical necessity determinations.