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Registered Nurse - RN

Company: ON-3 LLC
Location: Harrisburg
Posted on: June 28, 2019

Job Description:

A premier client of ON-3 is in need of a CONTRACT-TO-HIRE Registered Nurse (RN) to Create patient clinical summaries and anticipated treatment plans based on claims data. THIS IS NOT A REMOTE POSITION. Work is to be performed from 8 am to 4 pm Monday through Friday at the client site during the contract period. However, RN's are eligible for Work-at-Home privileges if hired directly. Primary activities include:Review and analyze high claimant and external carrier reporting packages.Ongoing 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.Meet productivity metrics and timeframes following orientation. QualificationsRegistered Nurse (RN)5+ years of clinical experienceExcellent written communication skills because the summaries they write are shared with finance, sales, underwriting and other non-clinical people.Well versed in looking at claims by code and description.Excellent computer skills and able to navigate in multiple systems at once - Trucare, Facets, Excel, Word, Encoder Pro, Up to Date, etc.Great organizational skills and self-motivated.Prior experience in healthcare provider insurance is a plus.NOTE: VISA sponsorship is not available now or in the future for this position.

Keywords: ON-3 LLC, Allentown , Registered Nurse - RN, Healthcare , Harrisburg, Pennsylvania

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