Medical Review Nurse

🔥 17 hours ago

❄️ Minnesota, Pennsylvania – Remote

❄️ Minnesota – Remote 🔔 Pennsylvania – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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Novacore

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1990

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Novacore is a specialty commercial insurance platform and managing general agent (MGA/MGU) that delivers tailored programs and underwriting solutions for complex and hard-to-place risks across sectors including healthcare, real estate, transportation, social services, reinsurance, and diversified B2B. Backed by a large network of agent partners and substantial premium volume, Novacore combines proven underwriting expertise with advanced technology and real-time analytics to accelerate quoting, improve operational efficiency, and support growth for agents and carriers.

📋 Description

• Assist underwriters in evaluating clinical and claim data during the disclosure process to identify potential risk • Work with Third-Party Administrators and producers as a medical resource for catastrophic claim management • Assist Case Managers with high-dollar catastrophic claimants • Evaluate claims reporting for potential exposure and reserve recommendations • Conduct clinical review and claims analysis to assess claim trends and possible group resources • Maintain patient confidentiality in compliance with IOA and HIPAA standards • Help seek and employ new business partners to promote healthcare resources and mitigate claims exposure • Serve as backup for other department medical staff as needed • Maintain licensure and certifications for professional advancement

🎯 Requirements

• Registered Nurse licensure preferred • Bachelor’s degree in nursing or science • CCM certification preferred • At least one year of acute care clinical experience required • UM or CM experience on either the payer or provider side • Prior TPA, MGU or Stop loss carrier experience highly preferable • Prior experience analyzing health care claims and coding • Prior experience working with catastrophic health care claims • Experience with data entry and analysis of medical reporting • Ability to provide risk assessment and communicate analysis succinctly in reporting • Ability to conduct independent medical research as an adjunct to medical underwriting tasks • Ability to meet tight time frames • Strong organizational and time management skills • Ability to work independently in a remote setting • Ability to work with multiple offices and underwriters and prioritize time frames • Strong data entry skills • Proficient with MS Office software • Ability to communicate effectively and professionally internally and with external clients • Maintain required licensure and certifications

🏖️ Benefits

• Competitive compensation and comprehensive benefits • Year-round social and community events • Ongoing mentorship and professional development • Endless opportunities for upward mobility • Collaborative, results-driven environment

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