RN Clinical Claims Specialist

Job Summary

A company is looking for an Associate Clinical Claims Specialist to assess and manage claims related to long-term care needs.

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 families to update health records and provide new plans of care

Required Qualifications and Education

• Current RN license in a Nursing License Compact state
• Minimum of 3 years of professional clinical experience in case management or home care, preferably with geriatric populations
• Proficient in Microsoft applications and workflow management tools
• Ability to handle inbound and outbound calls with various stakeholders
• Strong multi-tasking and time management skills