RN Clinical Claims Specialist

Job Summary

A company is looking for an Associate Clinical Claims Specialist.

Key Responsibilities

• Review clinical assessments to determine chronic illness status and develop plans of care
• Collaborate with field assessors and facility staff to gather necessary health information
• Communicate with claimants and their families to update health records and provide new plans of care

Required Qualifications

• Current RN license in a Nursing License Compact state
• Minimum of 3 years of clinical experience in case management or home care, preferably with geriatric populations
• Strong knowledge of Microsoft applications and proficiency with workflow management tools
• Ability to handle inbound and outbound calls effectively
• Strong critical thinking and independent decision-making skills