Simsy Ventures
11 - 50 employees
Founded 2022
🤝 B2B
B2B • Startup • Sustainability
Simsy Ventures is a venture builder and institutional co-founder that partners with entrepreneurs, investors, and corporations to create sustainable startups. Their mission focuses on enabling startups to achieve true potential while promoting a positive impact on profits, people, and the planet. With a structured approach, they support startups throughout their lifecycle, from ideation to market validation and growth. By leveraging a repeatable venture studio model, Simsy Ventures aims to uplift economies globally through impactful entrepreneurship.
Home Health RN – Medical Claims Reviewer
Job not on LinkedIn
🕒 May 18
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Simsy Ventures
11 - 50 employees
Founded 2022
🤝 B2B
B2B • Startup • Sustainability
Simsy Ventures is a venture builder and institutional co-founder that partners with entrepreneurs, investors, and corporations to create sustainable startups. Their mission focuses on enabling startups to achieve true potential while promoting a positive impact on profits, people, and the planet. With a structured approach, they support startups throughout their lifecycle, from ideation to market validation and growth. By leveraging a repeatable venture studio model, Simsy Ventures aims to uplift economies globally through impactful entrepreneurship.
📋 Description
• Conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines • Assessing medical necessity, appropriateness, and reimbursement eligibility while documenting decisions • Reviewing medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals • Educating internal and external teams on medical review processes, coverage determinations, and coding requirements • Supporting quality control activities to meet corporate and team objectives • Providing guidance to LPN team members and supporting non-clinical staff through training and discussions • Assisting with special projects and additional responsibilities as assigned
🎯 Requirements
• Active, unrestricted RN license in the U.S. and in the state of hire OR Active compact multistate RN license • Associate Degree in Nursing OR Graduate of an accredited School of Nursing • Two years of clinical experience plus at least two years in Home Health, Utilization/Medical Review, or Quality Assurance • Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings • Ability to interpret and apply medical review criteria and clinical guidelines • Proficiency in Microsoft Office and word processing software • Strong analytical, organizational, and decision-making skills • Ability to work independently while managing priorities effectively • Excellent customer service, communication, and critical thinking skills • Ability to handle confidential information with discretion.
🏖️ Benefits
• High-speed internet requirement • Private, lockable home office requirement • Necessary equipment provided including desktop computer and accessories
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