Clinical Review Nurse Specialist

3 weeks ago


Lake Mary, Florida, United States TurningPoint Healthcare Solutions Full time
Job Description:

We are seeking a highly skilled Clinical Review Nurse to join our team at TurningPoint Healthcare Solutions. As a Clinical Review Nurse, you will play a critical role in ensuring the quality and affordability of healthcare services for patients.

About Us:

TurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans. We are committed to improving patient outcomes and reducing healthcare costs through our utilization management programs.

Key Responsibilities:
  • Perform initial clinical reviews and provide documented recommendations based on established medical criteria
  • Review initial evaluation and clinical documentation against clinical standards, applicable state regulations, and relevant treatment guidelines
  • Assist clinical staff in quality improvement projects to provide instructive feedback to clients and providers within scope of practice
  • Resolve patient care issues by working one-on-one with community providers and staff to resolve issues in the determination process
  • Provide information by responding to queries of physicians and their practice staff, sorting and distributing messages and documents, and preparing information for determinations
  • Improve quality results by studying, evaluating procedures and processes, and recommending changes as needed
Requirements:
  • Licensed Nurse Practitioner (LPN) or Registered Nurse (RN) required
  • Comprehensive knowledge of general nursing theory and practices
  • Excellent customer service skills and phone etiquette
  • Proficient computer skills, including typing and ability to maneuver through various programs
  • Previous utilization management experience preferred but not required
  • Knowledge of musculoskeletal surgical procedures, cardiac procedures, pain management, and/or wound care is a plus
  • Ability to multi-task and manage tasks to completion on a timely basis and in an organized fashion
  • Ability to work collaboratively as part of a team
Salary:

$70,000 - $90,000 per year



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