Medical Claims Clinical Review Nurse

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

About the Role:

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.

Responsibilities:

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.

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.

About Us:

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.

This is a remote position.