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Medical Stop Loss Nurse - RN

Company: ON-3 LLC
Location: Harrisburg
Posted on: January 11, 2019

Job Description:

A premier client of ON-3 is in need of a CONTRACT-TO-HIRE Medical Management Registered Nurse (RN) to provide clinical and risk management support for the underwriting and stop loss departments in quoting medical and stop loss products for prospective and renewal business. Work is to be performed from the client site during the contract period. If hired, RN's can work from home. Primary activities include:Review and analyze high claimant and external carrier reporting packagesOngoing clinical review of high dollar claimants (medical and Rx claims) utilizing 50% threshold and breach reports among others.Development of case summaries including projected claim costs over the next 12 months.Participate in meetings with underwriting teams as needed.Provide support for external presentations; presents clinical data as needed.Review stop loss claim submissions to identify primary diagnosis, determine if claim detail is consistent with diagnosis, and determine if additional information or review is necessary for questionable diagnosis or services rendered.QualificationsRegistered Nurse (RN)5+ years of clinical experienceMedical Coding experiencePrior experience in healthcare provider insurance is a plusProficient in MS Word and ExcelExcellent communication and written skillsNOTE: Sponsorship is not available now or in the future for this position.

Keywords: ON-3 LLC, Harrisburg , Medical Stop Loss Nurse - RN, Healthcare , Harrisburg, Pennsylvania

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