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.