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Summary of Responsibilities:
This position is responsible to implement and coordinate a portfolio of researched Specialty Drugs, High Cost diagnoses within a dynamic research team. The Clinical/Financial Nurse Reviewer must possess organizational and prioritizing skills with the ability to manage multiple duties with close attention to detail, understand and conceptualize technical clinical and drug information, demonstrate initiative, and communicate needs and requirements effectively.
Duties and Responsibilities:
1) Requires a sound understanding of underwriting risk assumptions.
2) Utilize medical knowledge, clinical literature resources, and underwriting guidelines, clinical practice guidelines to assess course of treatments, diagnosis and protocols.
3) Maintain a directory of detailed components of treatments, drugs, procedures, while ensuring clinical adherence and integrity
4) Utilize critical thinking to collect, analyze and evaluate all relevant information prior to taking action. Apply data to underwriting and individual case management scenarios supporting both clinical and fiscal needs of clients.
5) Demonstrate good judgment to make decisions, adjust priorities, and make changes/additions to data where appropriate.
6) Manage schedule to ensure that accurate work is accomplished within the required time points. Ability to multi-task and adapt promptly to change
7) Self-directed with the ability to work both independently and as part of a team.
8) Perform other duties as assigned.
Qualifications / Experience:
1) Registered Nurse with 7-10 plus years of highly technical, analytical clinical experience. Clinical experience should include Hospital, ER, Acute / Chronic care, Medical-Surgical, Oncology or other catastrophic illness nursing experience
2) Experience in health insurance industry specifically Stop loss or reinsurance industry experience with catastrophic claims
3) Professional certification and insurance training preferred.
4) Demonstrated analytical and critical thinking skills.
5) Excellent verbal and written communications skills.
6) Strong team and collaborative skills.
7) Strong computer proficiency
8) MS Office Skills a must.
Nursing degree with current license.
Full Time positons available, work from home, Dental Insurance, Health Insurance, 401k.
Please send Resume to:
Stacy Borans, MD
Founder & Chief Medical Officer
Advanced Medical Strategies