MedPOINT Management

MedPOINT Management has been a leader in outpatient management solutions for over a decade. Our commitment to quality care and patient satisfaction has earned us the trust of both our clients and employees, creating a supportive and rewarding work environment.

Medical Claims Clinical Review Nurse

Location

United States

Posted

39 days ago

Salary

$36 - $48 / hour

Seniority

Mid Level

No structured requirement data.

Job Description

Medical Claims Clinical Review Nurse

MedPOINT Management

Role Description Join MedPOINT Management as a Medical Claims Clinical Review Nurse in Sherman Oaks, CA, where you'll play a crucial role in ensuring the quality and accuracy of medical claims. This is an exciting opportunity to work in a dynamic environment that values clinical expertise and attention to detail. - Conduct thorough clinical reviews of medical claims to ensure compliance with policies and regulations. - Collaborate with healthcare providers to clarify information and resolve discrepancies. - Utilize clinical knowledge to assess the medical necessity of services rendered. - Document findings and recommendations clearly and accurately in the claims management system. - Participate in training and development initiatives to enhance team performance. - Stay updated on industry trends, regulations, and best practices related to medical claims. - Provide support and guidance to claims processing teams as needed. - Assist in the development of clinical review policies and procedures. Qualifications - Registered Nurse (RN) license in California is required. - Minimum of 3 years of clinical nursing experience, preferably in a hospital or healthcare setting. - Experience in medical claims review or utilization management is a plus. - Strong analytical skills with attention to detail and accuracy. - Excellent communication and interpersonal skills. - Ability to work independently and manage multiple priorities effectively. - Proficiency in electronic medical record (EMR) systems and claims management software. - Commitment to continuous professional development and improvement. Requirements - Registered Nurse (RN) license in California is required. - Minimum of 3 years of clinical nursing experience, preferably in a hospital or healthcare setting. - Experience in medical claims review or utilization management is a plus. - Strong analytical skills with attention to detail and accuracy. - Excellent communication and interpersonal skills. - Ability to work independently and manage multiple priorities effectively. - Proficiency in electronic medical record (EMR) systems and claims management software. - Commitment to continuous professional development and improvement. Benefits - 401(k) - 401(k) matching - Company parties - Dental insurance - Employee discounts - Health insurance - Opportunity for advancement - Paid time off - Parental leave - Savings bank - Training & development - Vision insurance - Wellness resources Company Description MedPOINT Management has been a leader in the healthcare management industry for over a decade. Our commitment to excellence and patient-centered care has earned us the trust of our clients and the loyalty of our employees. Join us and be part of a team that makes a difference in the lives of patients every day.

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