Clinical Medical Review Nurse
23 hours ago
Job Summary:
We are seeking a highly skilled Clinical Medical Review Nurse to join our team at Three Point Solution. As a Clinical Medical Review Nurse, you will be responsible for reviewing professional and institutional claims, as well as provider appeals, to determine their eligibility for benefits. You will work closely with our medical and dental directors to ensure that our clients receive the highest level of service.
Key Responsibilities:
- Review and analyze professional and institutional claims using critical thinking and nursing clinical judgment.
- Communicate with medical and dental directors to ensure that claims are processed and adjudicated accurately.
- Participate in medical policy meetings and review sessions to stay up-to-date on the latest medical policies and procedures.
- Perform medical underwriting and risk assessment by reviewing applications and medical records.
Requirements:
- 3 years of acute clinical experience, with a focus on case management, discharge planning, or utilization review.
- Current knowledge of clinical practices and related medical policies.
- Strong organizational skills and ability to prioritize responsibilities.
- Excellent verbal and written communication skills.
- Ability to work independently and as part of a team.
Preferred Qualifications:
- Bachelor's degree in Nursing.
What We Offer:
At Three Point Solution, we offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and detail-oriented Clinical Medical Review Nurse looking for a new challenge, please submit your application today.
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